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HomeMy WebLinkAboutUntitled ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1� Date: 'TT_ Permit Number: I 77 s� Building Permit Application1117 JUL , 1 �.lyir Planning and Development Services FEEi'dIlT Building and Code Regulation Division St. Luc' ounty, FL 2300 Virginia Avenue,Fort Pierce FL 34982 a aunty Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line ©d ef �e,�/ PROPOSED IMPROVEMENT LOCATION: Address: 60(-( n z: Legal Description: - Property Tax ID#: �''� I °►-�I o O'�1"l —fin-S Lot No. Site Plan Name: Block No. O Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: C.�_/c CONSTRUCTION INFORMATION: Additional work toe e orme under this permit-check a appy: HVAC E3 Gas Tank E]Gas Piping _Shutters Q Windows/Doors Electric 0 Plumbing Sprinklers FIGenerator El Roof Roof pitch Total Sq.Ft of Construction: S . Ft.of First Floor: Cost of Construction:$ a L{CsQ- QCT Utilities:Sewer E]Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name Name: Address: !SbL ne_ Company: t�G�� ���5 r i roc City: 5hv-k t"� State:_ Address: 2,DE}t xpi Zip Code: F+-�c N57-- Fax: City:-- Z rye-e- State:-CL Phone No. L1C2q—2r, Col C3 Zip Code: -3(49LFax: E-Mail: Phone No. �1-Z=q 1°i 33 Fill in fee simple Title Holder on next page(if different E-Mail: �SC2CoMc o� from the Owner listed above) State or County License: CIBC I S-7 8U3 If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. ;:SU'PFLEMENTAL 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 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 commencinR work or recording our Notice of Commencement. X s Sign ure of Owner/Lessee/Contractor as Agent for Owner Sig ture of Contractor/License Holder STATE OF FLORIDA I STATE OF FLORIDA COUNTY OCOUNTY OF I�'_ , The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me thisday of 20 (,qby this day of 20 ff by _LLA IR(';mi U V, I I'l (Name of person acknowledging) (NanYe of person acknowledgin ) Ct—�&I AA 1, 10 L4 1. - (Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification 1/ Personally Known OR Produced Identification V/ Type of Identification Produced rG Type of Identification Produced L• Commission No. r MRIIN S. NIELSEN ommission No. �5 Seal =� Commission 8 FF 115637 ' ' �l �``R•=o''JJ KAREN S. NIELSEN - My Commission Ex it s June 12, 2018 My Commission Expires Revised 07/15/2014 '3�� ��"� June 12, 2018 m REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS