HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: d aa3 SCANNED Permit Number:
BY
St. Lucie County C Cqt CaS�Q�te } h�
9r--r
Building Permit Application aecELvEo
Planning and Development Services OCT 2 31018
Building and Code Regulation Division Pgr
2300 Virginia Avenue, Fort Pierce FL 34982 ��; np Department
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Res identiait §HofK
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
a h a0gi•'� a
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
3.535
� i�
Property Tax ID #: �'+ i/"�-- Lot No.
Site Plan Name: 7u-/'Le'y (. / G/&0 01/ i'u It't Block No.
Project Name: 4d~1 0`huV-5-
Setbacks Front Back: Right Side: Left Side:
I;DETAILED DESCRIPTION OF WORK: III
f J'j'f placer t?P" k"d:.0 G'L vim, t-
%� �/rav s� yc �rzrtr,,l aire� ,�.�dvt aA,- r-e- vic8��2P _
1,CONSTRUCTION INFORMATION: III
HVAC L_J Gas Tank
Electric 0 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Piping
LJShutters
❑Windows/Doors
nklers
0 Generator
0
Roof
=
Roof pitch
S Ft. of First Floor: _
utilities.. Sewer E] ptic
Building Height:
-OWNER/LESSEE:
CONTRACTOR:
Name 9'2JftQ6 OSJ'oCe24AW ik
Name: Wl
e`Sut-�
Address:
Company: 70►v�' 4 (tnn�S 1 j
City: e,- zr State:
Zip Code: S7 Fax: 77 7-- 7-7-S-37I (o
Phone No. -772-- 2w'2-F- .?JD h
Address: 3yr0 $_
�lG G�"Vl tV�
City: J:::r% • �{ i erc2
Zip Cade: 3LI�l� Z.
Phone No. 7'7Z ac
Stater
Fax: 77 Z
- 7ir3
E-Mail: 6L&4iyj 6750 0 eg�CaS�-cVl_eE
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: Sh • L&4 P a
(lLrr I h �t pJ S , Gw�1
State or County License: C1� c{ T
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: of Applicable
Name:
MORTGAGE COMPANY: _ of Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ of Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
rnmmpnrina wnrk nr rpr:nrdina vour Notice of Commencement.
Signature of Owner/ Lessee/C_o—nrr9MxrrmrAgent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
✓\
COUNTYOF
COUNTY OF
The org ing instr meptC was acknowledged before me
The forgoing instrument was acknowledged before me
this ay of vy 20 l by
this _cftay of 0e-A ?n¢ti 20& by
clqyNrl00SCs",
Sh�l Din �ol7sav�
Name of person making statement
Name of person making statement
Personally Known _ C— OR Produced Identification
Personally Known 14— OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
„ ,,
i
si nature of NotaryPublic- State of ula . ommission #
l .g
all"tur of Notary Public- State of FI
CHANTAL MO
„;` rpires October
Commission No.^�]� 9 "dTi T%Fi^�
G, 2019 `; Ccmmission #
WC�naerFiaea No. F
Expiresoclobe
n
,'•'IRi�i B"MWTNYTM1y Fin
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17