HomeMy WebLinkAboutBuilding Permit Application All P�ABLE INFO rMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I—4 I Permit Number:
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Building Permit Application DEC 0 4 2017
Planning and Development Services pL��.li"ilii 1G
Building and Code Regulation Division St. Lucie County,FL
2300 Virginia Avenue, Fort Pierce FC 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Lt C ,
PROP, ENT' ON:
Addres lo 1 — V o
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
-ee✓ -
CONSTRUCTION INFORMATION:
Additional work to be pertormed under this permit—check t at app y:
4/Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _ Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: n Sq. Ft.of First Floor:
Cost of Construction: $ �� �� r U l� Utilities: —Sewer —Septic Building Height:
Name C�i'l Ci C 4 Name:
Address: V Company: vl
City: f✓L_Q_ State:4EI, Address: 5 " t,
Zip Code: Fax: City: State:
Phone No. 7 Z — g$ Z --/7 72 Zip Code: Fax:
E-Mail: Phone No 7 Z
Fill in fee simple Title Holder on next page ( if different E-Mail I C U Q; OC
from the Owner listed above) State or County License l 70
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
UPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: - -
= r
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: I' Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: d 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
comnXpcing work or recording our Notice of Commenceme .
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDAII - STATE OF FLORIDA
COUNTY OF W(�,I� COUNTY OF 4 . LA)O,[F-.
The fg1going instr nt was acknowledged before me The forKbing instru gent was acknowledged before me
this day of J 20-q by this day of 20_4 by
A;rel ►�r-_oS
(Name of person 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 OR Produced Identification Personally Known OR Produced Identification
Type of Identifiers pn Type of Identif -o
Produced Produced
ELSEN
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KAREN o�# FF 115637 °<; KAREN
Commission commissm'ssio� i�es Commission No. 6pmmissi WLSEN
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Jun- xpirp.
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE VE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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