HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2.2 fltg2 Permit Number: �J '
R EC EWE
' xon S,
FEB 2 4 2017
Building Permit Application PERMITTING
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL'34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
P�ROPQSyED IRO, :uEM,�_�EaNT LOCATION:
Address: f r'/j/ P / L
Legal Description:
Property Tax ID#: 25, 1 o I " Q VQ f Lot No.
_ o
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
9TA.11114B DE5CR1'FTIO O°F WORK:
Sh2d TN
CONSTR+UCTIO IN'FOR Al"ION:
Additional work to be performed un er this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: �r Sq. Ft.of First Floor:
Cost of Construction:$ J 0 00 Utilities: _Sewer _Septic Building Height:
OV1/NE'R �LE�S�SE'E: CONTr R�`A�C'f®'R:
Name Name:
Address: 4) GU/ j J.Y Company:.
City: �/Ln2= Stater Address:
Zip Code: Fax: City: State:
Phone No. S 1 — �l 0 Zip Code: Fax:
E-Mail: ' .eaP Phone No
Fill in fee simple Title Holder on n t page (if different E-Mail
from the Owner listed-above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEM�ENT/�L CONSTRUCTION LfL�N LA^W NF®R ATI�N;
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: c 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 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
commencing work or recording our Notice of Commencement.
66�__� 11,11'kL
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA/. STATE OF FLORIDA
COUNTY OF t nft' COUNTY OF
The forgoing instr t was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20]q by this day of ,20_ by
(Na of person acknowledging) (Name of person acknowledging)
T �C
(Signature of Notary lic-kafe-6f State-6fFlorida ) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identific i Wally Known OR Produced Identification
Type of Identi ' 0 11 KAl2EN S. NIELS Nfyp of Identification
Produced B Commission# FF 115 'ro ced
� _* '= MY Commission Expires
Commission No. ;foF °;Seal) June 12, 2018
fission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.