HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
,per C ���WE
Building Permit Application MAR ) 0 2017
Planning and Development Services
Building and Code Regulation Division Lucie71?ounT I ty
St. Lucie County, FL
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
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: fb 12 0/� /7 L 11-le s 5-e 7110
Property Tax ID#: zlso2 . Sol t:597 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front_ Back: _Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be erformed under this permit—check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric ❑Plumbing Sprinklers 11 Generator E] Roof
Total Sq. Ft of Construction: /Cop 2'Z 5r�'` j S . Ft.of First Floor:
Cost of Construction:$ / '(� Utilities: Sewer j Septic Building Height:
OWNER/LESSEE: -CONTRACTOR:
Name o° ee f Name: &orA/ 7--O `e
Address: ,/ Company: t
/
City: J $' /> �,L State:rG Address:
Zip Code: o � State:
Fax: City: �'
q
Phone No. b/'1 75�33 Zip Code:3 Fax:
E-Mail: Phone No. Z G�
Fill in fee simple Title Holder on next 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.
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SUPPLEMENTAL CONSTRUCTION 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:
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.
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/Signature of Owner/Les ee/A`f nt Signature of Contc-tor/Licensle-Holder
STATE OF FLORID 7! ' STATE OF FLORID
COUNTY OF G/` �_ COUNTY OF
The forgoing instrument waq acknowledged before me The forgoing instrument as acknowledged before me
this day of 20by this day of 20 by
(Name of person acknowledging) (Name of person acknowledging)
AA
(Signature of Notary PdVic-State of F orida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification ProducedType of Identification ProducedL �
Commission No. 6 `....... I) KAREN S. N I E m sion No. I (Seal)
Commission FF 115637
My Commission E pires KAREN S. NIELSEN
i�91 1`pRY Pip�
b " _ - .Commission
Revised 07/15/2014 "�
sof. - My Commission Expires
°�' June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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MAR 2 0 201?
PLANf%W&DEVEWPf&WMRVICESIDEPARTMMT PER Vtt
B'UILI3MCa cCOM MGUI.MONSDIVMON 7Ttt�tG
2300VIRGUG"Vam St• Lucie County, FL
�It'rPLFRCB,)L 1,34982 SffiZ
(M)462-135"d
It NUSANYWAVU
L the undersigned,am the ov i cr ofthe following descrabedpwperV,
for•which I have applied to St Lucie County for. a F"ma Development Permit In
acct/ +.s.Fatl Development Pernik DP Number s I aCknowledge
Mast as owm-.of the above des+crx'bed.property, and is alccoixImm wii 11 Section
7.04.01(l)),SL Ducie Comte Land Developm &Cuk I shalt be r onslbie for'assuring
adequate drainage so that the mrn®ediate comnllunhy WHL NOT be adversely af€ectecL
I fi rdier acknowledge that in granting-ibis.pernft for the development of this proPCM,
St Lucie Couay is neither•obliged not liable to providefor, or mablain. in any form,
adequate drainage. off." my 'property wbieh wiiU not..-adversely affect the immediate ;
community:
Prop erw e(PImePrid)
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STATE OFFL0pfflA,COUNTY OF
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MY COMMISSION#FF187339
EXPIRES January 8,2019
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