HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ` ! j Permit Number: I
R- ECEIVED
Building Permit Application OCT 3 0 2017
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie nty, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: U— cr_�r L
PROPOSED INPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID#: Z-� Z J�3 BGG / �% Lot No.�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
AIZ 4) 2L
CONSTRUCTION INFORMATION:
Additionai wor to be pertormed under this permit-check all that appy:
_/�/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: $ 1, S(? Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name:-� �� 5 C/.c1••L
Address- d - / .201V 12IV41Z /L- Company: ez-
City: State: ,C�Z- Address:
Zip Code:54 U- 716 QFax: City: ��C i�` Stater
Phone No. 2' D ` Z Zip Code: Fax:
E-Mail: Phone No „Ye
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License 3
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN 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
commencinR work or recording ou Not' of Commencement.
Signature of wner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF v . L1j CI6 COUNTY OF
The f r oing instr as acknowledged before me The f ing instru as acknowledged before me
this day of 20 by this day of 20 by
KI Ki
Name of person making statement. Name of person making statement. /
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Ideatio Type of Identific
Produced Produced
d,
(Signature of Not (Signature o oar
KAREN S. NI E L S E N 'a;� 11kE1 5. NIELSEN
Commission No. •+ Commissio # F 115637 Commissi # FF 115637
'` ('k $ Commission No. " � �N
Commi Expires R0 y Comm Expires
;,;�;;;•` June 12, 2018 'o°�.o,,.���'� June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.