HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:^3 " (� Permit Number: 0 I
4; .J
1 J
- RECEIVED
Building Permit Application
Planning and Development Services MAR 0 7 2018
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 ST. Lucie country, Permitting
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: I
pL4-10
Legal Description:
Property Tax ID#: 4 - b000- OW-9 - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: � tie �. PaFm �
... +
�AP
CONSTRUCTION INFORMATION:
Additional work to be oerformed under this permit-check all appy:
11 HVAC Gas Tank ❑Gas Piping Shutters Windows/Doors
WElectric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
csa
Cost of Construction: $ �� ,k� `� Utilities: _Sewer[]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name:
Address: Company: - L
City: Stater Address: k
Zip Code: Fax: City: 1� State:
Phone No. _ �' ��Qp-`�U�� Zip Code: �K4Z Fax:-TQ tc...- L4L'o y�Q
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: �i -
from the Owner listed above) State or County License: t✓c _( _ Y�(1 n 3
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 thepermit 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 essee ontractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA nn STATE OF FLORIDA
COUNTY OF 1�1 COUNTY OF
The fo oing instrumen w cknowledge efore me The f r ing instru n s cknowledgVby efore me
this day of 20by this day of 20
Name of pers n making statement Name of pers making statement
Personally Known OR Produced Identification Personally Known I OR Produced Identification V
Type of Iden ' ' ti Type of Iden ' ' do
Produced Produced
Al 21 , , _
(Sig ture of Nota - a a of FIr, ' (Sign ture of Notar orida)
;ago"8,,, KAREN S NIELSEN ��`'"r' KARE ��S
Commission No. °r` ,nmiss&aIYF 115637 Commission No. °' -' += Comm;S� iFLSEN
-4 -
ar My Commission ExpiresMY Comrnissi f 115637
June 12, 2.018 — JU ne ) on Expires
1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
JOSEPH E. SMITH, CLERK OF THE CIRCUIT COURT - SAINT LUCIE COUNTY
FILE # 4409269 OR BOOK 4105 PAGE 1443, Recorded 03/07/2 1-"�
MAR 0 7 2018
NOTICE OF COMMENCEMENT ST. t_ucie County Permitting
Permit No. Property Tax ID No.I " 2 45 " 6ba�- Cab-
State of Florida,County of St.Lucie
The Undersigned hereby gives notice that Improvement will be made to certain real property,and in accordance with
Chapter 713,Florida Statutes,the following information is provided in this Notice of Commencement
Legal Description of property and address if available -id
General descript'on of improveMVy"
n
Owner/lessee IC / r
Address kA "t w
Y
Interest in property: N U- M
w cc
Fee Simple Title holder(if other than owner) _ co
Address
_ m
Contractor C Phone# v
Address Fax# - -��
CL
W
Surety Phone# 00 •w °
Address Fax# ""'O�
Amount of Bond LU o
Lender Phone# to N►_- O m O
Address Fax#
Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided
by Section 713.13(a)7.,Florida Statues:
Name Phone#
Address Fax#
In addition to himself,owner designates of
Phone# Fax#
to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes. Expiration date of notice of
commencement Is one year from the date of recording unless a different date is specified, WARNING TO OWNER:
ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER
PAYMENTS UNDER CH.713.13,F.S.,AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION.IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF
COMMENCMENT.
Owner/Lessee,or Owner's or Unsee's Authorized Otlicer!Director/PgrtneNManag,r/Signature
T 2E:7S I C) -1 1-
t SiErtatory s Ti!ts TI e� lOf Ice
State of Florida,County of tt--Acknowledged before the this ,day of �( �1 2C ,by L. L\ L�� ,
who is personally known to me or who has produced n as identification.
o K Y Y(l i I ykX 1',rillViat �Qf
Signature of Notary Type or Print Name of Notary (Seal
Title:Notary Public Commission Number l'C � �_
MORdr*MMC•tittiia M flattda
CoAni kOw i R 231585
Ay Cow,liplin Wp 31.2019
.°"°` Banded ttso 0 Meattil Notuy Assn.