HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -\' 1 Permit Number:3 Y1 o
Building Permit Application SEP 01.2017
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:
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Address: S S'. JS )-l-)O!-RW A;i '�OfLI _]A)nl� CllCi
Legal'Description: 1113
Property Tax ID#: 5� � — ��� S op,4— r bn Lot No.—
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: . Left Side:
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Additional worK to be perrormed under this permit—,checK all tat apply:
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:.$ oZ ! /�5 Utilities: _Sewer _Septic Building Height:
e3 A� ft,
* IL $ s rNT ? r
,Y'x:bGr ,., ..To-.rr.: >x2i'§``....
PRE-,
Name �� C'TO(�A L� Name: �—P- :.iGS(`.'J A-- DAA /-1
Address: M Pf a ST•. Company: eAS C.0 4i2
City,22, 1'FfAL_,0 State:' Address: __f.A-iJcaf11-7,i'L ZOL
Zip Code: 1 y'2-2,q . Fax: City: T::04j 1T0.-j State:
Phone No. Zip Code: -;�3 4'-.) G Fax:
E-Mail: Phone No ( - Xl-' 43 -0 D
Fill in fee simple Title Holder on next page(.if different E-Mail pfj�1/t. 3o0 C�Msirl t�, c�rv�
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name'
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 Associationrules,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 considefation of the granting of this requested permit;l 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 firs i pection. If you intend to obtain financing, consylt_with lender or an attorney before
commenci or or recordiDg your Notice of Commencemen !. `
Signature of r ssee/Contractor as Agent for Owner S natur of ont or/Lice se Holder
STATE FLORIDA STA 01 FLORIDA 1
COUNTY OF' COUNTY OF UJ
The forgoing instru ent w s acknowled' before me The forgoing instr ment w s acknowledge efore me
this day of 20�=1 by this day of 2Oj_ by
b s-�
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary.Public-State of Florida)
Personally Known OR Produced Identification ✓/ Personally Known OR Produced Identification V/
.,Type of Identific on Type of IdentificaYton
Produced L Q•L Produced B- �.• �• �-%
N S. NIELSEN r ;,;�,,
Commission No. � . -ommission No.r • i �( 1N S. NIELSEN
5:s.
C' i Sion A FF 115637 ommission k FF•11563My Commission Expireso7P1_. 3�,�0 0',;�: M,y Commission Expiresy .���.tt
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED .
DATE
COMPLETED
ev.