HomeMy WebLinkAboutBuilding Permit ApplicationM
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
z , ; --- II RECEIVED
Building Permit ApplicationMAR 0 7 2018
Planning and Development Services ST. Lucie County, Permitti
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
i PROPOSED INPROVEMENT LOCATION:
Address:. G C,t -p- Ll
Legal Descr1iption: 9 C ,_C1c r C_� Ltc-
C-
Property Tax ID#: 3 y U Z l i L4-00C) - F( Lot No. f -7
Site Plan Name: Block No. �
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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 V Roof _� Pitch
Total Sq. Ft of Construction: '[��lJ`51�. Sq. Ft. of First Floor:
Cost of Construction: $ ���_�(� , ( Utilities: —Sewer _Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name �tY r- Name: dC���,r-C-1 �-y C-�-A<-
Address: Company:
City: C_ State: �5T Addre s: Ce C CXL V� -40f—
Zip Code: ZL,
LR{ ;-Z Fax: City: /' -e__ Stater/
Phone No.--'5 ) -K01�� ��Zt Zip Code: ,3V/ ' Fax:
E-Mail: Phone No 3 Lz -ku)— 5�- Z'z
Fill in fee simple Title Holder on next page ( if different E-Mail C �.ti ) L 0 +I-cC,l.,c.� K-@ y►�E.-�9
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 FLORIDA I STATE OF FLORIDA I
COUNTY OFA • QL' (CCOUNTY OF t (:,(Eli;
The for oing instrument was qcknowledge efore me The forgoing instrument wa acknowledge efore me
this day of 20by this day of 20 by
:L2 0 1 c6r(4 cL
(Name of person acknowledging) (Name of person acknowl dging)
w
—:e' 1� k�
(Signature of Notary ublic-State of Florida , / (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification " Personally Known OR Produced Identification
Type of Identificotiqh Typ ntifica ' n
Produced _ Pro cgf!" L
°�;•,y KAREN S. NIELSEN =: 6``= '4«EN
<, ° Co on # FF 115637 ion nt gsi E E
Commission No. *: nn � Co a5fo. os MEL N Seal)
,., y'-on,, ission Exp res nmi 5637
June 12, Ssio
2018 Junta 12 2 Expires
°----
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TU LE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.