HomeMy WebLinkAboutBuilding Permit Application All APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / l / Permit Number: LZ
Building Permit Application AuG 14 261"
Planning and Development Services F,ER(!ij'[TiWG
Building and Code Regulation Division gt I uCie CoL!11t5', FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: , r
PROPOSED IMPROVEMENT LOCATIaN:
Address: 20I S • 3e_.. (�..� , P:•eeee✓ 57 t' 3 LO
Legal Description:
Property Tax,I D#: .230_-gol -000 J - 6co-0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED QE=�SCRI�P7ION t�F WO �K:
CONSTRUCTfO UNFORMATION:
ye—
Additional work to be pertormed under this permit-EEM all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters -Windows/Doors
_Electric _Plumbing _Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: , 5Y Sq. Ft. of First-Floor: �i'2 4-
Cost of Construction: $ 3o o Utilities: _Sewer X Septic Building Height:
sm,OWNsj gR LESSEE: CONTRACTOR:
Name (we.6 %'(a4lt Name:
Address: "70( Company:
City: State: Fff Address:
Zip Code:-3 (yc.(7 Fax: City: State:
Phone No. 9-o,00 - Zip Code: Fax:
E-Mail: Ca(��e.{-F������C_cc� Phone No
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.
i
SUPPLEMEN CONSTRU1'IQN LIEN LAIN"FO'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
commenci work or r coyAng yoWNotice of Commencement.
f �
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Signature of Ow er/;_essee/Co ractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The for oing instru en as acknowledge before me The forgoing instrument was acknowledged before me
this day of. 20JN by this day of 20_ by
Lap,
(Name of person acknowledging) (Name of person acknowledging)
• c
(Signature of Nota Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification V/ Personally Known OR Produced Identification
Type of Identific4l' na Type f Identification
Produced LDL KAREN S. NIEL LP,rud ed
commission 0 FF 1 5G37
Commission No. I � � � . I)My Commission Exp ssion No. (Seal)
June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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