HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: O �J
•
Building Permit Application NOV 0 7 2017
Planning and Development Services PEh'AITTING
Building and Code Regulation Division St. Lucie COLnty, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
r PERMIT APPLICATION FOR: F1i0 V-iCJA
I
PROPOSED INPROVEMENT LOCATION:
Address: 1 �� G1u/�P_,J Qj2 -h C_rl1Vg CT
Legal Description:
Property Tax ID#: IH 11-4 ' IG I , Q T f IW ' S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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L4 (Ace L..) IrtNj, to COC -
_771
CONSTRUCTION INFORMATION:
Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
;,Alectric _ Plumbing _Sprinklers _Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 9 Le), Utilities: _Sewer _Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name LL G - tName: rc
Address: 1. N C a r Company: Or, S . pD(G ELect<<u, LLC
City: �orT f l E/'CP Qi Stater Address: l(� �• 1TnrAa, 0/'_
Zip Code: 3H9 N- Fax: City: ✓e-ro j}eaG17 State: r_1
Phone No. Zip Code: 3.,2-9 1'6 Fax:
E-Mail: Phone No 77��, �`�- 06gt
Fill in fee simple Title Holder on next page ( if different E-Mail MC Y !?Lo ( () aOL, CO/1f
from the Owner listed above) State or County License 6 D Z(ZZ
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
commencing work or recording our Notice of Commencement.
0 1W I- 9 ae7t' ?�
Signature of O ner/Lessee/Contractor as Agent for Owner Signature of C tractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF J0,1 E, COUNTY OF
The forgoing instrume t was acknowledged before me The f rgoing instrument was acknowledged before me
this day of
V 20 by this day of 20 by
Umcn rif -(
(Name of pe son acknowledging) (Name of pers n acknowledgin )
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(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida ) /
Personally Known OR Produced Identification Personally Known OR Produced Identification I,
Type of Identification Type of Identificatior
Produced r'.. Produced r (
Commission No. KA {ejil);. NIELSEN Commission No. (Seal)
'`�• u�`�'- Commisslon# FF 1
"- Commission Exp -KAREN
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REVIEWS FROUF
VISOR PLANS VEGETATI �% ATUB L°mIni AM P(LyVE
COUNTER REVIEW REVIEW REVIEW REVIEW ne 12 REE, tw
DATE
RECEIVED
DATE
COMPLETED
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