HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1� I
Date: �mV�`i Permit Number: 1 V 40
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• DEC 0 6 2017
Building Permit Application
PLR"•gill�'ifdG
Planning and Development Services 5t. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: 11otJ s eml note, Pf1 Ve.'
Legal Description: `f C AY 0Orh )'Remo
ild
Property Tax ID#: 2��' TL 0 V 11 - Ow- (V Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
TAILED DESCRIPTION OF
a
Azo PlwArws 15 Ref"
Mm
Additional work to be pertormed under this permit-check all that appy:
_Mechanical Gas Tank _Gas Piping _Shutters _Windows/Doors
4lumbing
— Electric _Sprinklers —Generator Roof Pitch
Total Sq. Ft of Construction: "N S QF-r Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: Sewer Septic Building Height:
Name ost Perth Name:
Addresse4v►hh0le Company:
,
City: J Ofd P ► G� State:_ Address:
Zip Code:3Li61 Fax: `/ City: State:
Phone No. J i{s" 3 — �'i 1 ate,s.�► Zip Code: Fax:
E-Mail: (9 ! Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License
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.
Sig`iature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY COUNTY OF
The forgoing ins ument was acknowledged before me The forgoing instrument was acknowledged before me
this_U_day of o 20j5 by this day of 20_ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of IderLfication Type of Identification
Produced tt. Produced
6AR9-1
(Sign ture of Notary Public-State of Florida) (Signature of Notary Public-State of Florida )
°': :'��. dC�AREN S. NIELSE
Commission No. (S rtff C mission No. (Seal)
c Co mission S FF 1156 7
My Commission Expire
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.