HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /ry
Date: 1�,' �' �� Permit Number:
...................
Building Permit Application
DEC 0 12017
Planning and Development Services
Building and Code Regulation Division PERMHTfING
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie Co nty, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED INPROVEMENT LOCATION:
Address: � eje!I-[1J,// LA/
Legal Description: 7aFfP. daor clow.! (,ne)
Property Tax ID#: � ` � ' DO I�' l )�O 'Le Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front e, Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
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: '30 c� Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Name:
Address: G.n/O- &Jn4'4k�(l LN Company: A -7�cG� Csu>z:�tdr
City: r-1 Pa ecce State:�( _ Address: Yj6e%-W w--ti: -i'j'lrcedo
Zip Code: Fax: City: State: �c-e
Phone No. 7*7.)L - 2((,.- 7,/7S— Zip Code: 3V4< -7 Fax:
E-Mail: Phone No 77zk-5y2�
Fill in fee simple Title Holder on next page( if different E-Mail A •CAM
from the Owner listed above) State or County License
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.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA / STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing inst ment was acknowledged before me The forgoing instr ent was acknowledged before me
this_L day of bec 20j!Z by this_�_day of 204 by
Ar &f.6 fss#
(Name of person acknowledging) (Name of person acknowledging)
111L
c/'
(Sig ture o otary Public-State of Florida) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identificationy1 Personally Known OR Produced Identification t/
Type of IdentifiG'atior Type of Identificati
Produced Produced KAREN S. NIELSEN
S. NIELSEN - cion a FF 115637
Commission # FF 115637 " '- y M Co is on Expires
Commission No. " My Con45ea4ion Expires Commission No. °'f Ju ( 201 8
,r. June 12. 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.