HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number:
�RM RECEIVED
SEP 2 8 2017
Building Permit Application pER"BITTING
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
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PR 'PQSED :R �1/EME 7 LDCATI.� N
Address: Z/
Legal Description:
Property Tax ID#: �' { l� UU (3Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
�,E IfD DEQR L °Ip *- F
1116M.S%RUC I:0 FOR ATIO'IU:
Add
itiona work to a pe Orme• under,t is permit-c ec a that 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:$ 2- Utilities: —Sewer —Septic Building.Height:
Name y��`e ;Name:
Address: ;' S Company_:'
City:, StateAddress- ��
Zip Code:... Fax: City: State
Phone No. 3 S o ���� �y�� Zip Code: Fax:
E-Mail: Phone No 3
Fill in fee simple Title Holder on next page (if different E=Mail
from the Owner listed above) State or County LiAnse'
C,/&- J 0S 701
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S�U'RRLENI,E'N�TAL C0.NSTR't1CT'ION LbEN LAVI/ IN'FO:RI1/I/�TLON::
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 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 ano'thernon-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 ender or an attorney before
commencin o or recordingour Notice of Commencement.
0/�) al�
Signature o her/LesseeVCotractor as Agent for Owner Signature of tractor/License Holder
I
STATE O FLORIDA _ STATE FLORIDA
COUNTY OF COUNT OF e.
The f rgeing instru gent w s acknowledged before me The for ing instru nt s acknowledged before me
this day of 20 n by this day of 20,[ by
2LA 'J�� Pr612Ar6VA
(Name of personcknowledging) (N me of persona knowledging)
i
(Signature of Notary Pubi.c-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known70R OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Type of Identification
Produced ,,,,, REN S. NIELSEN Produced
ComLmission# FF 115637 """��� KAREN e
Commission No. My Uission Expires Commission No. :,`' ` : (§ ELSEN
June 1 2, 201 8 " ► mmission#FF 115637
+,foFr`OP � y commission Ex ire
e12, 201,8
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEAT E
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014