HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED II
Date:� p ' I� Permit Number: l rl `I /1 y -O in
RECEIVED
Building Permit Application OCT 0 6 2017
Planning and Development Services PERMIT',TING
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:
Legal Description:�rx l�hi (td n �
Property Tax ID Lot No.�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF.WORK:
�C�CJ
CO'NSTRI CTIO,N.INFORMATI:ON , 4;
Additional work toe r)ertormed under this permit—check all appy:
®HVAC Gas Tank []Gas Piping Shutters a Windows/Doors
❑Electric ❑ Plumbing []Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$SCJ Utilities: _Sewer❑Septic Building Height:
OWNER/LESSEE ,, j -CONTRACTOR:
Na Name: ,
Addresses: Compan
Cit y1" State: Addre
Zip Code: Fax: City. State:
Phone No. Zip Code: Fax:
E-Mail: Phone No. " 66 K7
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State County License.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMEIVl"AL CONSTRU -TIONRLIEN 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.
-JM/
Signature o O ner/ essee/Contractor as Agent for Owner Signature ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ulwct a COUNTY OF 5Ak)�1 1.._IiC C
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
this�day of QC"� ,20 1-"by this V day of (,c'I— 20-fby
Name of per on making statement NaW of pe on making statement
Personally Known OR Produced Identification Q>� Personally Known OR Produced Identification
Type of Identification Type of Identification
r c-e
Produced t, �l (c.l-2J5 L�Ce-nom ProducedV_+ yZ:�(�2�t� �%
_
(Signature o ary Public-St `e ofi ori ature of tary Public-Stat of F ora
Yi9d J.bIERSffOfd WI:P9Q KATHY J.MERSH013-HUKS
?rotary Public,State of FI r� a " flfl�otary Public,Stats of Io a
Commission No. aIJ Comm?ssion#FF 1993 10 mission No.oZ ��- d(� �' al/Cflmm?ssion FF 199 5
y comm.expires Feb.12,2019 PAY comm.expires Feb.1 , 19
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
',Rev.8/2/17