HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO. UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �( ��
Date: �" 2�I 200 Permit Number:
DECEIVED
F. .... �. m Building Permit Application AUG 31 2017
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982 '
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: 'Few C�,
PR'aPOS~ED INPROUEM"ENT L®CAT�If PN:
ddress: -7967 --Sc,
eS �arfi jer'G2 �L 72, u q
Legal Description:
roperty Tax ID#: � ' � Mrl .300- J Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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(9 r%)r-Ir P+e-
OR -S
eORMA ON:
Additional work to be performed under this permit-check all that appy:
_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:$ i Utilities: —Sewer —Septic " Building Height:
WNER/LE�S�SEE: CONT COR:
Name r%aD r,\ LA_-,)eA.)/10
Address: `20101 S Company -:'-(-_; _
City: 0 r State: 'L
Zip Code: 3 4 Fax: — City: State:
Phone No. 772- - SSS -,(O 3'C1 q Zip Code: Fax:
E-Mail: 6 w-eA\ S 4� Dj- 610AJ-tO - COv" ' 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.
SSU ° PLEMENTAL CONST �UCTI®N LI=EN LAININFO.RMATlON:
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 Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA LL 1 STATE OF FLORIDA
COUNTY OF cJ W C Ii, COUNTY OF
Thefjq�going instr`ment was acknowledged befor&me The forgoing instrument was,acknowledged before me
this day of 201 by this day of 20_ by
(Name of person bcknowledging) (Name of person acknowledging)
C
(Signature of Notary Public-State of F orida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification "� Personally Known OR Produced Identification
Type of Identification of Identification
Produced KAREN S. NIELSE:eto
ro ced
_ _°� `�': Commission# FF 115
Commission No. l '' Pj�$eMY Commission Expi ission No. (Seal)
u ••` 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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