HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: r �� � rl Permit Number: rl
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• NOV 0 3 2017
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Building Permit Application
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Planning and Development Services St. Lucie
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
[IPIR�MIAPPLICATION FOR:
MENT LO
Address: 6/ !'
Legal Description: /' o h/ 60 oZ
04 33s-s- - a
Property Tax ID#: 1/0.2- - 6/O - 01. 77 - OOO - Lot No. _
Site Plan Name: �lirdDG� ��' rsyo Block No.
Project Name: vi'�c-,� les;d4`!G
Setbacks Front _ Back: Right Side: Left Side:
DETAILED DESCRIPTIO(-MORK:
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SS1.-2 Gnat Sri�'�S S.SOO ,�/ �,✓5 /f�f'O�,a�G�'
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Additional work 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:
uo
Cost of Construction: $ ��, Gh'Jz'� Utilities: —Sewer Septic Building Height:
ESSE
Name Name: �/a/l c%1/
Address: /ice .('i'ii-v Company: 171eI ell, Loa.5/A _�C
City: State:f i�°�� State: / Address: o2-y0 Z i1,1-C
Zip Code: 3 y 9�/9 Fax: City: /r/ Al'el;:L t State: fL
Phone No. 77,?_ 2211 - 75 W Zip Code: 3 Fax:
E-Mail: Phone No 77a
Fill in fee simple Title Holder on next page (if different E-Mail f7Gl t/4 Q, y4'�dc" Losyt
from the Owner listed above) State or County License L�J--ef� - .1,5 r�--
If 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:
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.
Signature of Owner/Lessee/C ntractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA [,� STATE OF FLORIDA
COUNTY OF �t HIE COUNTY OF _ I�11� ,l�
The f oing instrum nt was acknowledged before me The fo oing instrume t was acknowledged efore me
this day of 204 by this•.. day of V 201 by
(Name of per on acknowledging) (Name of person acknowledging)
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(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida)
Personally Known O P-rQduced ldentffirgitinn Personally Known J OR Produced Identification
Type of Identificat in, KAREN S. NIELSEN Type of Identificati
Produced ;:`•"' Commission# FF 115637 Produced "�'��" KAREN S. NIELSEN
as My Commission Expires R= Commission# FF 115637
.a„o�,.� * My Commis x ires
Commission No. June O1 8 Commission No. s p
June 1� �0'18
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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