HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ZS Permit Number:JR a '
RECEIVED
_Rffiul M,- 3-
Building Permit Application AUG 31 2017
Planning and Development Services PERMITTING
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: To Select from dropbox, click arrow at the end of line
PROPOSED_IMPROVEMENT LOCATION: _
Address: 2/ 040 5—Jevl 0, Fl- 3 Y 4'S)
Legal Description: La v_'Pwooa
C D 3767
Property Tax ID#: O -3 - O VO — 1 Lot No. r
Site Plan Name: Block No. C(o S
Project Name: ���Y--)
Setbacks Front Back: Right Side: Left Side:
DETAILED: DESCRIPTION OF WORK:
CONSTRUCTION'I'NFORMWTI'ON:
Additional work to be nerformed under this permit-check all=appy:
11_HVAC Gas Tank Gas PipingShutters Windows/Doors
E—Generator
Electric Plumbing OSprinklers Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 9 , `1 -7 S Utilities: Sewer Septic Building Height:
OWNER/LESS EE:k CONTRACTOR:
Name � e Name: j SS e
Address: -710(o 0�t ei„ Company: Q\f 6 r'9� C vl�
City: F r-�— f ev^C-e State: Address: 3100 0\1 Y1m11-11 .
Zip Code: 3`-(9s ) Fax: City: !j�?s_ `e� 2✓`C�. State:��-
Phone No. `77 Z Ltlo S 3 -7-7) Zip Code: -3 5 Fax: -M'2-
E-Mail:
MZ E-Mail: Phone No. 7 2 )S
Fill in fee simple Title Holder on next page(if different E-Mail: Ay��y.rr�C6��f S fir,v�� e✓s i C.a7 D
from the Owner listed above) State or County License: _-2 y 3
ai i •�v
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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:
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.
S`gnaturt of Owner/Lessee/ ontractor as Agent for Owner Signature of ontractor/License Holder
STATE OF FLORIDA 7 STATE OF FLORIDA
COUNTY OF COUNTY OF
The f oing instru ent was acknowledged before me The fing instrum t was acknowledged efore me
thisday of 20 by thisday of 20by
Name of person making statement Name of perspn making statement
Personally Known_�OR Produced Identification Personally Known ,✓ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
1
V` AA
(Signature of Notary Public-State of Florida) (S gLure of Nota ate of Florida)
Commission No. (Seal) Commission No. � KA EN
om
KAREN M rnrssion# �fLSEN
,SPP PPI Iy:�� S. NIELSEN ' °'noa.
Commission k FF 11 5637 J omMrsslonF 1 5637
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es
REVIEWS F ""�, s N -"EERVISO PLANS VEGETATION SEATURTL R E
COUNTER RE REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17