HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: d-1 J — Permit Number: l O
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-W-01 La I hN,IN RECEIVED
Building Permit Application FEB 15 2018
Planning and Development Services
Building and Code Regulation Division 5T. Lucie counRy, Permitting
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: Ul LL
Legal Description:
Property Tax ID#: ��" Lot No.
Site Plan Name:9416 �i Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
&.I- L 5�b w, w *'(1 r1ii1w C,4% wl LO
CONSTRUCTION INFORMATION:
Additiop,al work to e er orme under this permit—check a appy:
HVAC M Gas Tank []Gas Piping _Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers E Generator 11 Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
9'
Cost of Construction: $ Utilities: _Sewer Septic Building Height:
OWN R/LESSEE: CONTRACTOR:
Name &ot ArAeuName: qA
Address: AqA p—bW Company: �S AQA1 Wd &440
�A
City: Stater Addre : L( 3 5W
Zip Code: Wl pp Fax: City: 1r S' . /Z� State:lli-
Phone No.e /' �`"0 S 5 Zip Code:V3y953 Fax:
E-Mail: A/& Phone No. N"
Fill in fee simple Title Holder on next page( if different E-Mail:
from the Owner listed above) State or County License:
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
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF low, COUNTY OF
The for oing instr men was acknowledged before me The fo oing instr ertt was acknowledge efore me
this�day of 20 by this Z day of 20 by
Ft t'j OS!,ee PC-Q A t'3 CSS J
Name of person making statement / ame of person making statement
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identification Type of Identificat� n
Produced _ Produced—
(Signature
(Signature of Notary Public-S a (Signature of Notary Public-State of Florida )
KAREN S. NIELSEN
Commission No. Com in(Seall)# FF 115637 Commission No.
My Commission Expires
018 —
., °'.a °�B°,.,
KAREN S. NIELSE
June 12, 2N
Commission A. FF 115637
;Y •F - ` Jun 12. 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION —
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17