HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2 -2J (p Permit Number:
RECEIVED
- F-B 232018
Building Permit Applica ion
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 j
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential V
PERMIT APPLICATION FOR: Q
PROPOSED INPROVEMENT LOCATION::
Address: "7 r Ir eZC.- nl f i u e II
Legal Description: [-07" t a/,, C-k Fd,; 1- La->_5 nil �iLtJcs.nci Civ b
Property Tax ID#: y�'t• • y Qd � Lot No. �(
Site Plan Name: Block No.
Project Name:
Setbacks Front l l( , (, Back: f 4,'K Right Side: 17 S Left Side:
DETAILED DESCRIPTION OF WORK:
I C- (`4e $ C, n d , n.s�'�t l ('� c. r e,1'e C' �ri r-
7- c-k-
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CONST LICTION INFORM
Additional work to be performed uncle t is permit-check all that appy:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
Electric _ Plumbing _Sprinklers _Generator _ Roof
Totaf Sq. Ft of Construction: 360 s Sq. Ft. of First Floor:
r G
Cost of Construction: $ I t7 Utilities: —Sewer _Septic Building Height:
0
Name 1n ��'. !1 SBY� Name:
Address: 7 w q 4. i'3v rn o t.)l p( r Company: 1^ S C n r-,c rPTe
City: Sr, L c. e- State:F • Address: �L f, S : _ �r(� �, r-e
Zip Code:3gg51 Fax: City:? o r?' ST. L State:FL
Phone No. Zip Code: � 417 Fax:
E-Mail: Phone No '77.)- S 9 -7S L(-7
Fill in fee simple Title Holder on next page( if different E-Mail & 1S (It-JE (d atUQ. COO-
from the Owner listed above) State or County License—_3 n S 7 C1
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 see/Contractor as Agent for Owner Signature of Contrac License Holder
STATE OF FLORIDA41 STATE OF FLORIDA
COUNTY OF COUNTY OF
The foroing instrum t was acknowledge before me The for oing instru was acknowledge before me
thisQday of 20 by this day of 204 by
(Name of person acknow edgin (Name of person acknowledging)
1
(Signature of Notary Public-State of Florida ) / (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identifficotion T e of Identifiion
Produced "" KAREN S. NIELSE r ced M06 �L
Commission# FF 1151537
Commission No. s .!E$eM� Commission Expi eco ission No. F
=L% June 12, 2018
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETA EA T
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
37
DATE ' '
`�° nr• mission# FF 1 56
COMPLETED `
11/1'v'C'ommission Ex fires
ev. un
Je 12, 2018
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