HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `
Date:To 1 Permit Number: \"
� RECEIVED
Building Permit Application JAN 19 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X.
PERMIT APPLICATION FOR:
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PROPOSED IMPROVEMENT LOCATION:
Address: ill�(K _5;✓ '�:�GrL� e�.l C its t� S L t L- �LASG 2.
Legal Description:
Property Tax ID #:73 �7:�_ -701 0 (ILI LOP25' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: J
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _ Plumbing _Sprinklers _Generator Roof 12 Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �;` ' Utilities: _Sewer _Septic Building Height:L2in-24 _
OWNER/LESSEE: CONTRACTOR:
Name LySZILewSK-c �Tc2(�Vt4 SILD S Name: SLge;,.tr,�
Address: 14 :�r-' U<- )J Company: .4
City: VS(, State:l_C
Address: t t_� �t> .4UE
Zip Code: ' QgJZ� Fax: City: FX- State:
Phone No. '-M,) I (,: Zip Code: 4Gg Z Fax: 777_ qf,_t -L-iy6�
E-Mail: Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License CG U `S -7
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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.ynr pro erty. A Notice of Commencement must be reco .dectand posted on the jobsite
before the fi St ' sp n. IfVou intend to obtain financing, consult w' ender or an attorney before
commencir,4y6orXor recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/Ljcense Holder
STATE OF FLORIDA '; STATE OF FLORIDA L `l 4
COUNTY OF AE. COUNTY OF �c U ow_
The forgoing instru ent was acknowledged before me The forgping instr ment was acknowledgedpefore me
this day of 20 by this day of 20J L by
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(Name of person acknowledging U (Name of person acknowledging)
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(Signature of Notary Public-State of Florida ) (Signature of Notary Public-Sta—te—of Florida ) /
Personally Known OR Produced Identification V/ Personally Known OR Produced Identification ✓
Type of Identifi atio Type of Identifi"tipn
Produced Produced
" KAREN S. NIELSEN , �a ops•, KAREN S. NIELSEN
P ny ri
Commission No. °�, Commi�g FF 115637 Commission No. ,= Com(nq 1pn# FF 1 1563 7
My Commis ion Expires My tom fission Expires
June 12, 2018 June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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