HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� Permit Number: `)
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. __.m. Building Permit Application MAR 2 4 2017
Planning and Development Services PEr;(fTfi;lG
Building and Code Regulation Division St. Luc;s Couni• F-L
2300 Virginia Avenue,Fort Pierce FL 34982 (//
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION .FOR: 1
PROAOSEADTIN.PROUEMENT LGICA 10
Address: ��� 5 L����To�� � � 3-9�
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D ILLD DE�=' RIPTIDIV' O WOR'
CQNS•TR'UCTLON tN`F�RM 'T ION:
Mona wor to be performed under this permit-Check afl 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:
u0
Cost of Construction:$ —> -C-O Utilities: —Sewer —Septic Building Height:
Q� yNE'R/L �SSE°E:
Name ° ���[ C�,u/ �� Name: a
Address: �ioa6�' / /�/ 7-r�vz. �G Company:
City: �-w? Q) State; Address:
Zip Code: -11W.. Fax: 6�2 City: � ��`L��°6z- State:
Phone No. Zip Code: %r3 Fax: "VAQ
E-Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail Z/�i31//Jm-�c9zfrom the Owner listed above) State or County License -��61300�
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
�U'PP�LEM'E� TL CO.N>STR!UCTI:O-N LIEN LAW LN�FO,RMATir�`'N.
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 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.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID► STATE OF FLORIDA l 1
COUNTY OF'� , .� COUNTY OF , , , E)
The for oing instrument wa acknowledged before me The forg ing instrument w s acknowledged before me
this day of 20 by this day of 20 by
61v v
(Name m
person acknowledging) (Nae person acknow edgi g
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida) /
Personally Known OR Produced Identification Personally Known OR Produced Identification d
Type of Iden ifi tion Type of Identification
Produced uced �(,
(S�KAREN S. NIELSE I�omission No. (Seal))
Commission No. = e.- mission 8 FF 1156
Z,- My Commission Expii s
`8 s'
June 12
'' KAREN S. NIELSEN
, 2018
Imi Sion It FF 115637
111 X REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION # ;, t1Rfft j�
COUNTER REVIEW REVIEW REVIEW REVIEW
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DATE
RECEIVED
DATE
COMPLETED
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