HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: IZ Il Permit Number: 1A 1 a- a3
J SCANNED
BY
MEW St. Lucie County
REC�T�/cD
® Building Permit Application DEC; 7 JiS
Planning and Development Services
Building and Code Regulation Division S S. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from'dt Pboi',- dliek 9'rFow at the end of line W*A t� °I Q W
PROPOSED IMPROVEMENT LOCATION:
Address: ) ::I, u 1
7y AA ,T oovr R ; dote T�LV DrA
Legal Description: iyCf 5i i 1l ° 2. Vyt , 3-s
Property Tax ID #: N y 3'tc - 5- 10 - 0 03. l ' O 00 -`, Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: ,1
Block No.
CONSTRUCTION INFORMATION: III
LJHVAC LJ Gas Tank UGas Piping
Electric 11 Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ V 'SSS , 03
Shutters Q Windows/Doors
Generator Roof = Roof pitch
SgI�Ft.
. of First Floor:
Utilities: �ISewer ElSeptic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name C1I`*V1! S ha A i
Name: -oS(,oh ��p,1vccc-h o
Address: 114')'^i 0a r iZ n
Company: MoMem=1 (-lg 53
t S
City: 5k L"c : C.. �-c,. .i State:VV
Zip Code: Fax:
Phone No.
Address: 5't /'` ortLr)
Rr>
City: 11
Zip Code: 1111 al°1`1 Fax: I-U
Phone No. 17L ),3 I°l-�`t
State: F L_
iB3 (R 1)
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: C 15-,n . J-nCt✓It S 311
State or County License: �5 to
Co
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAWINFORMATION:
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
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 'nspection. If you intend to obtain financing, consult with lender or an attorney before
menclniz wok or recording vour Notice of Commencement—
)'al�
011
caner/ Lessee/Contractor as Agent for Owner
Siffilallre of Contractor/License Holder
STA JOF FLORIDA
C NTYOF SC (.>(
ATE OF FLORIDA L v ct
P,
COUNTY OF J
The for oing instrum'ef�n,t, was acknowledged before me
II &R—C
The forgoing instru ent was acknowledged before me
� �
this day of . 2016 by
this day of 20� by
�s�h i�e�.,e«�,,o
3"«t
Name of p rson making statement
Name of pm,n making statement
Personally Known u OR Produced Identification
Personally Known __ \\ OR Produced Identification
Type of entification
Ty of Identification
oduc
P o uced
tary Public State of Florid,
Lisa Greer Bharalh
Q., 4�-1Gy ,��� y,ci �,• My Commission FF 982709
'!o, Expires 02H SI2020
po
ignature f. Pt{ �ry� �edRr�Utri)P�°jj
(Signature of Notary Public - State of Florida )
My Commission FF 962709
Commissio N Explmso2/19/202o (Seal)
CommissionNow_oq�n (Seal)
dJ
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17