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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED y Date: ! 7 ZS Permit Number: RECEIVED Building Permit Application JAN 2 9 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 PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION: / Address: C L Legal Description: O P)-Cb4 1 SLe 6 R 2 7516 '-Z 63 L4.U-) IT F Property Tax lD#:3VZD 16-0 R OL39 7 ©0O ` 6 Lot No. Site Plan Name: /v t1_1 Block No. Project Name: c ,dam� Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: — D O pew' ova pe pt'04Ce 41 SI��wGC�S' [CONSTRUCTION INFORMATION: Additional work to b rtormed under t ispermit—check all that apply: HVAC Gas Tank Gas Piping F Shutters ❑Windows/Doors Electric ❑ Plumbing Sprinklers ❑Generator L .Roof �/ Roof pitch Total Sq. Ft of Construction: '��©� S . Ft. of First Floor: Cost of Construction: $ t 7 j (/-co Utilities: _Sewer E]Septic Building Height: OWNER/LESSEE: CONTRACTOR: Name GJAName ©a- Address: y.<- C(1z Company: City: C Stater Address: d( S ND/R UJ Zip Code: gZ Fax: City: f P Stater Phone No. Zip Code: 3 g(Q !Z Fax: E-Mail: Phone No. 67r ,5-7y 9kl q Fill in fee simple Title Holder on next page ( if different E-Mail: � K-PG/DuPGtW�t��i/e6a�17 r from the Owner listed above) State or County License: CGL 0� � 3 If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. ac\5 1 SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENG�IIE�E _Not Applicable MORTGAGE rAW: Not Applicable Name: //yy Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLF�HQLDF : _Not Applicable BONDING COMP Y• Not Applicable Name: U �- ) 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 1 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 ' spection. If you intend to obtain financing, consult with lender or an attorney before commetfc-ing wor or recording our Notice of Commencement. i ture Owner/Lessee/Contractor as Agent for Owner ofCo�ntrtor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF Sr L-uL! COUNTY OF c-! e The for oing instrument was acknowledged before me The for oing instrument was acknowledged before me this day of "A�Ut�� ,20by this day of u IQK 201,a by �2 L PJ cc•y Name of pe son making statement Name of person making statement Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identifi ion Produced roduce Alf *Commission Pu ' -State �Iworid$i(AM AAE (Sign ure of o ry ubli ate of Florida) ro.......46 4Se9}"ffii5"#001"W Commission No. f MIe +, JUN Is,am • 1f,2�t1 ''FofA� �adNllw�p�N�q �r �'* ��►yr�tMwr►*1yIM REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.8/2/17