HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLEINFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ` 01 1' Permit Number.
RECEIVED
Building Permit Application OCT 2 7 2017
Planning and Development Ser0ces P E M-!I1'TI N G
Building and Code Regulation Division St. Lucie COUnty, FL
2300 Virginia Avenue,Fort Pierce FL 34982 r
Phone:(772)462-1553 Fax:(772)462-1578 -Corr mercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: I c 3 Cl
Legal Description: A�r _s/rw/y' l 1h
()— L i , I. ' z Ldp G R `f05�-1��
Property Tax ID#: J 3 06 � Q� —�� U OO 3 Lot No.__2L_
Site Plan Name: qvt S C-4 c S c,r1l(,PCZ S Block No.
Project Name:
Setbacks Front Back: Right.Side:, Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Add
rtiona wor to e e rme under this permit—checka appTy—_ _
13HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric a Plumbing Sprinklers Generator Roof
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Total Sq.Ft of Construction: c So. Ft.of First Floor:
Cost of Construction:$ Q000-00 Utilities:11 Sewer D Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name � d L r--,) v e Name: tiC
Address: r Company: /4 r C H-k"
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City: vice00
Mate:�L Address: Z 6' lE
Zip Code: 3��/ S Fax: G State:,SL
Phone No. 7 7 1 � �- Zip Code:13 L(tfr - Fax: zMv
E-Mail: A44 Phone No.
Fill in fee simple Vile Holder on next page(if different E-Mail:
from the Owner listed above) State or Coun icense:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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:
r
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 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 roomsand 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 ith lender or an attorney before
commencing work or recording our Notice of Commencement
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORPD�1 _ STATE OF FLORIDA L
COUNTY OF �1T l 9C1� COUNTY OF
The Ing instrup� acknowledged fore me The forgoing/instru t acknowledged before me
thisday of L J 20 by this' da of 20Y
C �e r r� 6W
( ame of person acknowledging) (Name of person acknowledging)
(Signature off Notary Pu ic-State of F orida) (Signature of Notary blic- ate of Florida)
Personally Known OR Produce Identification Personally Known OR Produced Identification
Type of Identification Produced 1- nL. Type of Identification Producedr aQl.
Commission No. Commission No. KAREN E L S E N _
<AREN IELSENCo
_
�_. mmission # FF 115637
c Connnisswn # FF 11537 M
June 12, 2018
. °' June 12, 2018
Revised 07/15/
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS