HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
Date: I I' Z Permit Number: ' l
(A9
R• '' IM
Building Permit Application NOV 2 8 2017
Planning and Development Services PERMHTTING
Building and Code Regulation Division St. Lu ounty, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: �JZ L ryl01/' �Rt�i ` ✓`
Legal Description: S0 G"0-1,®In (t/el k c, 4 < -
Property Tax ID#: Z 1 • S,()2, QQz1:�- coo ' •J Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Sp c' blot^
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric r?�lumbing —Sprinklers —Generator — Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 0tn/i 0L'— 'n' Name: AL�v �Ifv✓ l��!-��
Address: -1Z-L Company: V,r'o0p1,
City: State: r Address: ? Z T S ur_9 G4_ka ti✓ L, h
Zip Code?,YS rq Fax: - — City:1� ��
C State:
Phone No. Zip Code: I(e S- �!Y Fax:
E-Mail: Phone No J
Fill in fee simple Title Holder on next page ( if different E-Mail r
from the Owner listed above) State or County License-9
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMAT ON:
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,swiming pools,fences,walls,signs,screen rooms and accessory us s to another non-residential use
WARNING TOO N�R: Your ilure to Record a Notice of Commencement r ult in your paying twice for
improvements toAyour proporty. A Notice of Commencement must be:•fecor and posted on the jobsite
before the first inspection-If u intend to obtain financing, consult b /� h ) der ttorney before
commencinR work or ridcoilAing your Notice of Commencement.
i
Signature,pf 6wrWrl Lessee/Contractor as Agent for Owner Sign at/ 7ontractor/License Holder
STATE OF FLORIDA STAii OF FLORIDA
COUNTY OF 4. COUNTY OF
The for oing instrum t was acknowledged before me The f ng instrum nt was acknowledged before me
this day of Q 20� by this day of 1J• 20 fa by
yje(� �Is Karl k r I t_�n r608 I
(Name of person acknowledging) (Name 01
person acknowledging
1.12
(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification L// Personally Known OR Produced Identification
Type of Identif' tion Type of Identifi Lien
Produced (., L 1 Produced
KAREN S. Atl
Commission No. .R •��. KAREISe%I)NIELSEN Commission No. ate' mission 5637
=R R,
=' Commission # FF 115637
.R .= , My Commission Expires
My Commission Expires
„;..• June 12, 2018
REVIEWS F R PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.