HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z Permit Number:
- .II RECEIVED
- APR 03 2018
Building Permit Applicatio
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential L/
PERMIT APPLICATION FOR: \
PROPOSED IMPROVEMENT LOCATION: - t
Address: L`S \
Legal Description:
Property Tax ID#: b C)2 r (Dc)(:_-)- 2 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
I
CONSTRUCTION INFORMATION:
Additionalwork e per orme un er this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator LZRoof Pitch
Total Sq. Ft of Construction: �Z d (� Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
OWNERAESSEE: CONTRACTOR: I
Name -'DA Name: JC T L
Address: 2 ' C' Company: v2-
City:
ZCity: . , e,(LQ State: F71 Address: G( c.` ✓vt
Zip Code:?;qC1fl Z Fax: 2 -p City: State:
Phone No. 4 Code: `3L-L`l, _?— Fax:
E-Mail: Phone No TA CL —L(<QL Z
Fill in fee simple Title Holder on next page ( if different E-Mail t,oc1 - �.,c,>A
from the Owner listed above) State or County License ZIL4
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 II STATE OF FLORIDA
COUNTY OF COUNTY OF
The foing instr ent was acknowledged before me The f oing instrume t was,acknowledged, efore me
this day of 20 by this day of 20 by
kJ
I Ell C11,I LC
(Name of pers n acknowledging) (Name of person acknowledging)
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(A-LID Ak
(Signature of Notary Pu ic-State of Florida) (Signature of Notary Puic-State of Florida)
Personally Known �7OR Produced Identification Personally Known .//blOR Produced Identification
Type of Identification Type of Identification
Produced Produced
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1111111,,, ````�,*P•'PLe i',,
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KAREN S��NIELSEN A N S. NIELSEN
Commission No. r,w =_ Con,m;ss11 I
FF 1 1 5637 Commission No. _. �__ d Alf
ssion
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MY Co N FF 1 1563
My Commission Expires Commission
J Expires
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGR
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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