Loading...
HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO FIALIST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: f Permit Number: _.r=te ,.�;vv�,�.,.�(,�%�`-�:T'��:.;`�=.'•�;':SI'x'( RECEIVE Fl.a>N Building Permit Application FEB 2 1 2017 Planning and Development Services PERMITTING Building and Code Regulation Division St. Lucie County, FL 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: ,PROPOSE:D INPROV-MENT LQCATIO ,. Address-/K-?2e//5lJ��-- Legal Description: Property Tax ID#: LA © - I ` - c5n Lot No. Site Plan Name: Block No.' Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK I Q itiJ �� W CONSTRUCTION INFORMATION: Y 2it-wchanical ona wor to a pe orme un er t is permit-c ec a tat appy: _Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric _Plumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ Utilities: —Sewer —Septic Building Height: OWNER/L SEE CONTRACTOR Name Name: N� Addre : Company: 'c City: tate: Address: Zip Code: Fax: City: ' ! State:4�— Phone No. Zip Code: 3L Fax: ��-a —�i�'I`, E-Mail: Phone No. a Fill in fee simple Title Holder on next page (if different E- 'I from the Owner listed above) State County License: If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTALSCONSTRUCTIQN LIE 'INFQRI�//IATIN �� N LAWO E � z �.'t��,:`t yx ENRfit aCt....�, _,,.,��,,�,.<,..xA „k#`., DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY. - _Not Applicable Name: Name:. Address: Address: City: State: City: State: Zip: Phone: Zip: Phone: FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable Name: 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 thepermit 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 commencing work or recording our Notice of Commencement. Signature of Owner/Agent/LesseeSignature of Contractor/License Holder STATE OF FLOR STATE OF FLORI A _ COUNTY OF • \ Y, COUNTY OF kA)e The forgoing instrument was acknowledged before me The forgoing instru_rrientt was acknowledged before me this`�:Il day of ��Q,(� ,20i by this day of 2011� by (Name of person acknowledging} (Name o person acknowledgin r I C7-- �Qr (Signature of NotaiV Public-State of Florida) (Signature of Notary Public-State of Florida} / Personally Known OR Produced Identification Personally Known OR Prod Identification r' Type of Identification Produced , �. Type of Identification Produced Commission No. Commission No. KAREN seal4lELSEN T PyO( KA S. NIELSEN , ar PUBS— 115637 Commission# FF 11 5637 ��� `�'= Commission# FF I Com fres ' *_= M mission Exp I_ June June 12, 2018 REVIEWS FRO "" PLANS VEGET �'Ci"' MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.