HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �t
Date: a i� ti SCANNED Permit Number:
BY RECEIVED
- ' St. Lucie County
Building Permit Application DEC 17 2018
Planning and Development Services / ST. W09 E4bintyf PermMIng
Building and Code Regulation Division V
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line - CQ ��� III
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: 61'_VkJ TWMS, C.0070NNCt M0h^ A %)L)rT '309
Property Tax ID #: 35 35 -101 - DOW - M 0' C 1 Lot No.
Site Plan Name:
Project Name:
Block No.
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Chl—
CONSTRUCTION INFORMATION: III
J Gas Tank
0 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 'JZ clio . r9n
Sas Piping LJ Shutters
Sprinklers E]Generator
S Ft. of First Floor: _
Utilities: Sewer E]Septic
Windows/Doors
Roof = Roof pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Or-f SQA K SgLS,-
Name:
Address: �yq� S BCQOkJ '� lX�1SX ?-�fAA
Company: 0\
City: l Z0Q_ l 7 State: eL
Zip Code: Fax:
Phone No. `lico• 3 • zffl
Address: N 1 $ •i., p
b I
City: 51QP19-� I Stater
Zip Code: -__'5,kadM Fax:
Phone No. 2 • XRR
E-Malie, C NS AVi> I ON a
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: , IkLLL, N1 ) C _bAPIC k_ , &IA
State or County License: �S $
If valu f uc#aN9M90t9Pffl&M a ICORDED Notice of Commencement is r Notary Puclic State of Florida
fP Lisa Greer Bharath Lisa Greer Bharath
A My Commission FF 962709 _ gyp` My Commission FF 962709
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Address:
Zip: Phone:
_Not Applicable
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 antl 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 financingyoas� lender or an attorney before
com g —wort or recording vour Notice of CommencLTm ent.
caner/ Lessee/Contractor as Agent for Owner
SignaZoactor/License Holder
TE OF FLORIDA
STATIDA
UUNTY OF rn 4 (�
COU A^at
The f(rgoing instrument was acknowledged before me
The forgoing instrument was acknowledg d before me
s N thiday of . 20A by
this day of W6V 20by
Name of person making statement
Name of person making statement
Personal] Known t OR Produced Identification
Personally nown OR Produced Identification
Type of d ntification
_�
Type of I tification
Produ ed
roduc
0
0 "A"�
Signature of Notary Public- State of Florida)
(S' nature of Not ublic- State of Florida )
Commission No. (Seal)L
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
v - "'�"' """---�- - -_-- - �.�Y°4v. Notary Public State of Fbdda
Rev. 8 2 17 g Lisa Greer Bharath r
�7` My commission FF 982709 Llsa Greer Bharalh
Expires 02/1812020 y, My Commisai0n FF 982709
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