HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number:
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,_ RECEI\/Fr'
Building Permit Application ,JAN o
Planning and Development Services ST. Lucie County, Herr
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: RECEIVED
Address: 5 33 0 CA R(Ivy AOr `
J Z018
Legal Description:
ST. Lucie County, Permitting
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
[DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
itio a workto a performed under this permit-check a appy:
HVAC Gas Tank F]Gas Piping _Shutters Q Windows/Doors
11 Electric Plumbing U Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 4 2 O L) Utilities:0 Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name K)4Ai!-) 4 ),/ATlr-t SC14 ,5 Name: C.1iAX4 JLkV,r—
Address: � '. G✓ C,11 S.(;UA./ r0 Company: COLO �=M-'J �►
City: S ' �. State:_ Address: e3 N �;2 I LLN
Zip Code: -3`'j'171�11 Fax: x City: State:LL
Phone No. Zip Code: 3 `1 Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: /;,2 L1GA i`ry t3
from the Owner listed above) State or County License: W
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
commenc,iDg work or recording our Notice of Commencement
Signatur of Owner/Lessee/Contractor as Agent for Owner Signatur ontra or/License
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The for oing instr ment was acknowledge efore me The forgoing instru ent was acknowledged before me
this day of %Qt�1 20 by this�� day of 20J�by
V-A un 1.14:p,
Name of person making statement Name of person making statement /
Personally Known OR Produced Identification V Personally Known OR Produced Identification
Type of Identification Type of Identificatinn
Produced Produced
LAA
(Signature of Notary Public-State of Florida) (Signature of Notary Public
KAREN S. NIELSEN
C'
Commission No. EN S. N1ELSEN mission No. _ ,, CQSeallsion# FF 1156
My Commission Expire;
Commission # FF 11563 June 12, 201 8
e �- �,;ec,��
- = My Commission Expire. ��`"��
REVIEWS FRONT I i SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17