HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number.
; IVEE)
Building Permit Application OCT 2 7 2017
Planning and DevelopmentSer0ces PER?/iI1TIyG
Building and Code Regulation Division St. Lucie County, Ft-
2-300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 -Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, dick arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: L-r e c v
Property Tax ID#: U "�J��d LIQ Lot No.�
Site Plan Name: 5/0 ay, s i c eS' _ n �V Block No.
Project Name:
Setbacks Front Back: Right.Side: Left Side:
DETAILED DESCRIPTION OF WORK:
1
fin- 11 �r� f G
/a x
a
CONSTRUCTION INFORMATION:
Additional work to b-g-ortormed under this permit-check all that appy:
v
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric F-1 Plumbing Sprinklers a Generator D Roof
Total Sq.Ft of Construction: �cT Sq. Ft.of First Floor:
Cost of Construction:$ G 0 d Utilities:USewerFISeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name C, Name: C." C
Address Company: u C A !"Z-
city' r .date:jL�-c Address: 4 vt Im
Zip Code: City: F V'(Cp-c i State:�L
Phone No.
Zip Code:1.3 (IF - Fax: 7 -2,;-'W r`v-M,7
E-Mail: Phone No. 7 Cf1�/'"s.3 6 P�
Fill in fee simple Title Holcier on next page(if different E-Mail: ce pC(r
from the Owner listed above) State or Coun icense:
ff value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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:
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 thepermit 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,screearooms,_and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in youruaying 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
comme0apg work or recording our Notice of Commencement.
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA 1 STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgping instru acknowledged b for me The fRr ing instra i'was acknowledged before me
this day of 20 acknowledged
this qday of C 20�by
c,-I r/ a 2 14/r,(�z 6,--y lkv�L ? (f 7
(Name of person acknowledging V ( ame of person acknowledging)
1
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR ProduceO Identification Personally Known OR Producedldentification ✓
Type of Identification Produced (, (1(J Type of Identification Produced
Commission No. Commission No. KAREN( ELSE N
+—� PEN S. LSEN _ Commission # FF t 15637
Commission # FF 115632 - M Commission Ex fires
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June 12, 2018
June 12, 2018"'"'"�``
Revised 07/1
REVIEWS - FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS