HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I I
Date: Permit Number: /LJ�
RECE EVI
Building Permit Application MAR 0 6 2018
Planning and Development Services
Building and Code Regulation Division ST. Lusie C u ty, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982 7
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 IMPROVE ENT LOCATION:
Address:
Legal Description:
Property Tax ID#: ��-' �� (�)� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
lc� C' ,
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[CONSTRUCTION INFORMATION:
Additional work toe er orme under this permit-check a appy:
❑HVAC 11 Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric ❑ Plumbing
Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ _ -�' Utilities: _Sewer a Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name:
Address: Company:
City. State: Address: l l7
K CA
Zip Code: 2 Fax: City: Vr StateII ff
Phone No. Zip Code: �j� Fax: _YCV(-`-t
E-Mail: Phone No.
Fill in fee simple Title Holder on next page ( if different E-Mail: n
from the Owner listed above) State or County License: L�0( (.045
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
a
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.
Signatu of.Owner/Lessee ontractor as Agent for Owner Signa Arefntracto /Licen Holder
STATE OF FLORIDA STATORIDA
COUNTY OF � ;C>>IF, COUNTY OF '
The forgoing instrument wa acknowledge efore me The f rgoing instr nt wa acknowledge efore me
this M�day of 20_by this�day of 20 by
Name ofperso making statement Name of per on making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
i
(Signature of Notary Public-State of Florida ) (Signature of Notary Publi I „
_• *= co�ei;i S. NIELSEN
Commission No. ”"" AREN IELSEN Commission No. _ on #FF 1156
;: "',�o,`���; My Comm on 37
Commission# FF 115637 ss Expires
June
My Commission Expires 1z, 201
l
REVIEWS FRONT OR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17