HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONW-:
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �t
Date: 12/26/2018 SCANNED Permit Number:BY
Sf. Lucie County RECEIVED
Building Permit Application DEC 2 6 2018
Planning and Development Services ST. Lucie Coun Peitti
Building and Code Regulation Division �,---rm-
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial x Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line E1e,%r�o4l
3P,ROP�OSEDIMP�RQUEMENTLCiCAI ION:
Address:
Legal Description:
Property Tax ID q: 00O I — da0 —S Lot No.
Site Plan Name: Block No.
Project Name: Florida Turnpike Service Plaza
Setbacks Front Back: Right Side: Left Side:
provide 30amp 120v circuit to tankless water heater in Mens and Women's bathroom.
wire is 10/2 with ground MC cable to 120/208 panel
sCONSTRUCTION INFOkMATIONi {
Mona wor to e e orme under tispermrt—c Fe a apply;
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[JHVAC �GasTank ❑Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof = Roof pitch
Total Sq. Ft of Construction: _
Cost of Construction: $ 2100.00
S Ft. of First Floor:
� Utilities: Sewer Eheptic Building Height:
OW,NnER%LESSEE:
`CONTRACTOR
Name v-M
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Name: /r0L Ali
Address: Z d6tP4 CL/D
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Company: y naw/tq fiGGLTgr t � l/ar (0 media/�t�
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Zip Code: �3 cri Fax:
Phone No.
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City: tlA" �.411k State: L
Zip Code:`5?'y/`z Fax:
Phone No. 772 "`776 033a
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: WA9JeL-6e Z (,/Xi k) NE7
State or County License: e UW 307
V, moie, a ncuunucu notice or commencement is required.
}SUPPLEME L'CONSTRUCTIONwLIENtLAW:INFMMATfON"
DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not 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 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
commencinvlwork or recording vour Notice of Commencement. .
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Signature of Owner/ Les ee/Contractor as Agent for Owner
Signature of Contractor/Lic nse Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF -S V_ Ly k"4
COUNTY OF S�-_ L%Jz%-Q
The forgoing instrument was acknowledgerj before me
The forgoing instrument was acknowled ecj before me
this day of b%K .20� by
this'.�o day of Dce .20� by
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Name of person makin ement
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Name of person making ement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced �•.� V
Produced k- i) L
(Signature of Notary Pu ic- State of Flori P4g (Signature of Nota ublic-State j
MpfilE�� p�023 t
Commission No.G60 d� � paw ce At.dee2No^'� mmissi � qG 'u'
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0dA°dTMypotstl OPIRE
REVIEWS FRON ING SUPERVISOR PLANS SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17