HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE-ACCEPTED,
Date: Permit Number:
R�. DECEIVED
�• � BUildin Permit•A lication
g pp OCT 0:2 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:
P ®POS�D INPR;O�V,EM=ENT L(*OCATION:
Address:
Legal Description:,
Property Tax ID.#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D'E ILED DE=�SYCRE PTION OF 1N0 .�.
X0101 VC,
CONSTRIUCTIO f'NFQRMATI®N:
Additional work to be performed un_ er.t is.permit-check all that appy:
)OMechanical _Gas Tank _Gas Piping _Shutters _Wind`o.ws/Doors
Electric Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:.
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
OWNER/LE�S�SEE: FEE R,ITI
Name. Name:
Address i ���� R `I t' Company:" ,So of G� 6' he
City: m I 1lClStater Address: - !,
Zip Code: 3'��1 Fax: City: F0 „• lam /State:-
Phone No. 5-lrl Zip Code:, . S F �Tb —
E-Mail: a ! bC54 oig aq re .CO Phone No a(�
Fill in fee simple Title Holder on next page (if different E-Mail S - 19 b VAC hl l�'.
from the Owner listed .above) State or County License l l• ;F
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
5UMUNINE40I LIEN
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address, Address:
Gity,,i v r '-i" State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: —Not Applicable
-
N a m df="' Name:
Addre"9s'! 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 your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF 4— . � COUNTY OF A,-
The tKgoing instrofts ackinowled before me The tring instruatftas, acknowledge d_before me
this day
20 by this day of by
_Lg',
n 1(3 V1
(Name of person ack wledging (Name of person acknowlecl&g�-'
C:
A I
(Signature of Notary Public_State of Florida) (Signature of 140'tary Public-State of Florida
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of ldentifi.cajiion Type of Identificatj'
Produced- SEN Produced
NIEL
KAI<t:l" J-# FF 1 15637
ion
miss J�E xpi,e s
Commission
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commission# FF 115637 KAREN
Commission No. F SEN
Exp Commission No.
com"'(5
W June 12 201
I- n o
I 1-Y comm(5e* Cornmissio 15637
orn june 12, 8 Ycornmissio Expires
June 12
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANG VE
COUNTER -REVIEW REVIEW '-REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED T
DATE
COMPLETED
Rev. 7/2014