HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number.
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Building Permit Application MAR 1 55 2017
Planning and Development Services PERFAITTING
Building and Code Regulation Division St. Lucie
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PR�P®:SE0 I1NRROUEMENT LOCATION:
Address: S003 —6 rl 0 Jif_
Legal Description:
Property Tax ID#: 3 o — b — v 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: ' Left Side:
DETAILED DE�SCRI' TION10YJ/1'l o I WO +K•
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CQNSIT[RUCTINN I INFOR{ ,&TION:
Additional work to be perrormed under 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: Sq. Ft..of First Floor:
Cost of Construction:$ 3 aD t Utilities: —Sewer _Septic Building Height:
Q NER/LESS C® TRACTOR:
Name cr Name:
Address o I�l Company:
City: Stater Address:
Zip Code: 3
C Fax: City: State:
Phone No. 3 Zip Code: Fax:
E-Mail: 5 (( �� Phone No
Fill in fee si pole Title Ho er on ne 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.
SUPPLEMENTAL C®NSTRUCTI®N LIEN LAW INFORMATION:
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 recordin ur Notice of Commencement.
Signature of Owner/resseeficontractor as Agent for Owner Signature of Contractor/License Holder
_STATE OF FLORIDA L 1 STATE OF FLORIDA
COUNTY OF sk.l 3 r�I COUNTY OF
The forgoing instrument wa acknowledged before me The forgoing instrument was acknowledged before me
this A5_day of 20f by this day of 20_ by
(Name of person ackn wledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) / (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Typeof Identification T e of identification
Produced KAREN S. NI E L j'r5uc
= Commission V FF 11563' I'1
Commission No. a My Commission =CDml7115Y1On No. (Seal)
June 12, 2@18
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014