HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �(
Date: Permit Number: U�
RECEIVED
" - APR 03 2018
Building Permit ApplicatiLPLuc"e
County, Permitting
Planning and Development Services --
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: C
PROPOSED IMPROVEMENT LOCATION: v
Address: L.c_- (f- ( C(���24
Legal Description: ��'--e r�5��(/ . C�"r4Ir'✓l e /-
l a (2-1L' 7 -�Y- .3 1 - ��'f
Property Tax ID#: 7� un ' LZ—A I - LL� 2 Lot No.^�3
Site Plan Name: Block No. -
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _ Plumbing
cc��� _Sprinklers _Generator L f Roof _ Pitch
Total Sq. Ft of Construction:_' CSi�C.) Sq. Ft. of First Floor:
v�
Cost of Construction: $ � zau Utilities: —Sewer —Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name�Lk C_kc- Name: w _1�- L �G
Address: V--C_.LLAC' Company:
City: ? �-S L State: b Address: U C 4, t -, vv-
Zip
kZip Code: JL'�"L�Z Fax: City: 11' L_ State:
Phone No. Zip Code:S�4c."'�Z Fax:
E-Mail: Phone No __)1.1:::,(17-
Fill
Fill in fee simple Title Holder on next page ( if different E-Mail t
from the Owner listed above) State or County License L'� C)
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/Lice ns Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF �C,( COUNTY OF
The fpggoing instr ment was acknowledge before me The fo oing instru ent w acknowledge efore me
this�day of 20_4 by this day of 20_Z by
L �,�r�� �( LLL hC i C
(Name of person acknowledging) (Name of person acknowledgI I AA JA
ing
(Signature of Notary Pub cc-State of F o ida ) (Signature of Notary Pub ic-State of Florida )
Personally Known W--,/OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced "�"""'� Produced
N I E L S E N
Commission No = �."'mission �'eFF�1tl15637 COmm155
�-
'77omm ss�d�i�YkpirW_i KA NIELSE
June 12, 201 8 0 _ Commission # FF 115637
sal ioc My Commission Expires
_ June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEG MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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