HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L(� Permit Number:
RECEIVED
Building Permit Application JAN 16 2018
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential Z�
PERMIT APPLICATION FOR: l
Address: ��� <; 004 5+ (—L)CA Q F14 2) 95--,_
Legal Description: 5)024toni b"� o q0 C
Property Tax ID#: 3q;R-7 III O b0---- UC )cD5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
ETAILED DESCRIPTION OF WORK:
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A f, �
Additional work to Be�pertorme'a under this permit-check all that appy:
__Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator L—I:Gof 1�z. (Z Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: 2Lt�,U
Cost of Construction: $ Cosi ��� Utilities: _Sewer _Septic Building Height:
Name S 1 ewP(LI) Name:
Address:A1 '(Y 461IL W &�_ Company: RV_ W _C_ZA-CA,r�
City: e-3rk SA ik I I State:_EA!� Address: 0_1d&2 SL Ad LV u >'�
ma � �1
,
Zip Code: ' y�' Fax: City: t v r s} d-\lCkd d State:_�(G�
Phone No. �Z�- (0 '1���3� Zip Code: _2'�qCl SZ Fax:
E-Mail: Phone No -7 -2 2 `5 7-ri 4 5 kZ
Fill in fee simple Title Holder on next page ( if different E-Mail C L Cll/A 1 Q L j -�- C A g,_An 1r( e 4hAA
from the Owner listed above) State or County License _q O'i1
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 recoi din our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA I .0 STATE OF FLORIDA I
COUNTY OF 1 0 ,I�� COUNTY OF -If
The forgoing instr ment was acknowledged before me The forgoing instru ent was acknowledged before me
'
this v day of N 201a by this�day ofPAIJ 20�Z by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification 1// Personally Known OR Produced Identification
Type of Identification Type of Identif p ion
Produced Produced R ,
1
(Signature of Notary Public-State of Florida (Signature of Notary Public-State of Florida )
•a,,,u,/ NIELS5 N
Commission No. ., o rni CSS' FF 1 7
Commi � Commission N ;r,. 9,y' K e RE N
•- MY Comm ssion Expires ;+� o,n-�zN S. N
r e 12 2018- _ �= Commis
on a FF 115637
June 1 2 201 8
REVIEWS FR ZONING SUPERVISOR PLANS V ROVE
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DATE
RECEIVED
DATE
COMPLETED
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