HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f
Date: /5 /8 SCANNED Permit Number: I
BY
t = St. Lucie County RECEIVED
Building Permit Application NOv 3 0 2ot8
Planning and Development Services
Building and Code Regulation Division
ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial N/ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSEDYMPROVEMENT LOCATION:
Address: •Li/ 0 0 A/ A t)AP�/.�au�2A� , [[e6w- �t vnvd
Legal Description: eQ� hunk /7!. non.. rQaa ,QQ.C.�i.: a 3.
Property Tax ID #: f �fa3-30o
Site Plan Name:
Project Name JAdaaun ,... C a4t
Setbacks Front Back:
Right Side: V Left Side:
Lot No.
Block No.
DETAILED",DESCRIPTION OF WORK " `
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CONSTRUCTION INFORMATION: `
Additiona work to e performed un ert ispermit—check all apply:
]HVAC Gas Tank []GasPiping _Shutters ❑Windows/Doors
IVI
Electric OPlumbing Sprinklers 11 Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
3� Cost of Construction: $ a . co Utilities: Sewer Septic Building Height:
OWNER/LESSEE_ :
CONTRACTOR:
Name% .� . li14,9 ..
Name:
Address. 3YS
Company: � ad I Jza.
Address: oo# K 63-
City: JL Aet,e., State:
Zip Code:349N 9 Fax:
Phone No. _R4,6.1,64-23y7
Cityjki State:
ZipCode:.34905 Fax:'= -Wei -DVS'
Phone No. -Y=-4,G/- a'2'27
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:m,*& LO.ph& d
State or County License: 4t /3a- 385 9
sc,� s
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEIVIENTAt CONS1 RUCTfON IEIy�LkV1/rINF,OEtMATIOIV
:.s
DESIGNER/ENGINEER:
Name:
X Not Applicable
MORTGAGE COMPANY:
Name:
k Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_)L Not Applicable
BONDING COMPANY:
Name:
XNot Applicable
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 Counttyy 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 inspect n. If you intend to obtain financing, consult with lender or an attorney before
commencing work or/recbrding your Notice of Commencement.
Sign ture of Own/Lessee/Contractor as Agent for Owner
Sign5ttrrg of CDntractor/LiLvense Holder
STATE OF FLORIDA
STATE OF FLORIDA
�1
COUNTY OF -541 /.Yr / t W i(e _,
COUNTY OF 64s �]r 7✓uc,o
The for oing instrument was acknowledged before me
The forgoing instrum ent was acknowledged before me
MDUW662--
this7dayof &10WA4ftX-- .20) �' by
thisdayof 2018'by
li,ae6kA-�a, 92c1bE
Name of perscr} making statement
Name of pe�rson�naking statement
Personally Known 1/ OR Produced Identification
Personally Known 1/ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
-Public- e o Florida
(Signature of NoTin;
(Si
)
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Commission No."'':'= PPS�II''
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070973
Ex ires June 8, 2021
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REVIEWS
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VEGETATION
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COUNTER
REVIEW
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DATE
RECEIVED
//130f,s'
DATE
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COMPLETED
Rev.8/2/17