HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date: I6�aol8 Permit Number: �O 4- 1
J _ _ RECEIVtp
Building Permit ApplicationLAPR 1 7 2018
Planning and Development Services
Building and Code Regulation Division ie cou-ty Nrmitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �e
PROPOSED (IMPROVEMENT LOCATION:
Address: tXJU , ft� a teS DZ U b i i �e 8 gas
Legal Description: CNe_woo j) t1NiT 9 BLK 11 S 16-K /0 WL) I )
Property Tax ID#: Sol-6/l— o3 o7 ooal5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
-TA, (p or) 0-6- New 6 ' WOOD Pi-cv-a- F-Wce_ IS-o' .
CONSTRUCTION INFORMATION:
Additional work to be nerformed under t ispermit—check a appy:
HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
U Electric 0 Plumbing Sprinklers E Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction: $ ��,t_ . C Utilities: Sewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Rei ;L- TenPr ruR(vex Name:
Address: t 6o N iDAEo RbeYes Qtv 1) Company:
City: Fo&T- P('e-ace State: FL Address:
Zip Code: 3 V q S/ Fax: City: State:
Phone No. 77 2-- Y s';6- 6 W S Zip Code: Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
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 STATE OF FLORIDA
COUNTY OF COUNTY OF
The for oing Inst ment was acknowledge efore me The forgoing instrument was acknowledged before me
this day of 20by this day of 120_ by
(Name of person acknowledging) (Name of person acknowledging)
r�
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(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
"'P d, al�:AREN S. NIELS
Commission No. ,,�;.a� tom fission No. (Seal)
Commission # FF 11 637
- o My Commission Exp res
REVIEWS FRONT I�G SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. //2014