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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �f _ Date: Lr Permit Number: 1 I Building Permit Application APP 2 5 2N7 Planning and Development Services PERMITTI�NIG 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: PROPOSED fNPROUEMENT LOC•ATI'ON. Address: j 301 Susen Ll1 Legal Description: Property Tax ID#: 1 �J oc, SM' C 1&5- U C0 ,0 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DE�ITA';LED DEASCRI�PTlON CSF VVOR+K, 1 R- Fct f i k a Z-/ 4 se.p� CONSTRUCTION I�NiFO'RMATION: Additional work to be performed under this permit-check all that appy: 1/ 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: $ �, y/� Utilities: _Sewer _Septic Building Height: OUVNER/LESSEE: � � �®NTRA�TOR: Name,'cn 7��•� �,'Je �' Name: � V��► Address: 5 X61 YL'.5 c' Company: LCLa .4y So1u4,('-' s City: 7 Pl li iJ State: 'F Address: 6150 C 3 C cbcn a f-� Zip Code: '341 S' Fax: City: 1-% State: C' Phone No. '�7�; �7� Z ys'� Zip Code: Fax: E-Mail: Phone No—C PI- y`1`7 / Fill in fee simple Title Holder on next page( if different E-Mail CGG i Qt r<aU`(D) G P-CA, � I , C0'rn from the Owner listed above) State or County License C-AG I 'i 19 009 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLEMENTAL @©NSTR�UCTION LIEN LAW III! RMATION: 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 0 er/Lessee/Co tr cilor as Agent for Owner Signature of Co ractor/Licen! der . STATE OF FLORIDASTATE OF FLORIDA COUNTY OF �A. Loolb COUNTY OF The forgoing instr ment was acknowledged before me The forgoing instr ment was acknowledged before me this .day of 20-1!1 by this Z day of 20by C (Name of person acknowle ing) (Name of'prson acknowle ing) f (Signatu of No aryPu -State of Florida) / (Signatur of Notary Publ`3cc to of Florida) Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification t/ Type of Identification Type of Identiflc tion l Produced Produced ; n (� Commission No. 70', )KAREN S. NlEL [C�m� fission No. / Commission # FF 115637 .,. o,.,, AREN S. NIELSE=� °= Commission S FF 11 67My Commission Ex ires _ *_ June 1 2 2Q 8 yr�,'a,: ` - it s 1\ \° ,f�FF�• June 12, 201 REVIEWS FRONT 3ff#*J T "SAS VEGETATION S j -- COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.