HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r,,
Date: L �� �� Permit Number:
RECEIVED
•
- APR 17 2018
Building Permit Applicati T. Lc,- ounty, 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:
PROPOSED IMPROVEMENT LOCATION:
Address: &JQ!CB TftSC) gL�,C � k�4-VC
Legal Description:tl S- Azi L 3�Co� F (.,� 1�04D L (-c(- - l 2� s I C-2f}T�S
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Property Tax ID#: \-30 Bc� Lot No.
Site Plan Name: Block No. ':31 _
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
acv 6k'c_rk Slfl�
CONSTRUCTION INFORMATION:
Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ZTI�. Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: 3-0wt4STd N�
Address: 9'LibO 1nfi!,So 000gNt3 LV Company: 1 N
City:�PL( PIECuC_ Stater Address: (08,2 1\1 L,) ^WJ-Hoa_c 3�v
Zip Code: 3g`'15- k Fax: City: ?,Sc_ State: F1
i
Phone No. 2-? 70--(o( Zip Code: 34C )!�7 Fax:
E-Mail: Phone No SL_.c - S 1 p' —63 G C)
Fill in fee simple Title Holder on next page( if different E-Mail 1 tJ fo (�C'./ C1t-"IAO -• CG'
from the Owner listed above) State or County Licensee 30S^U'y
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
co ing work or recording our Notice of Commencem
Si nature of Owner/Lessee/Contractor as Agent for Owner Sign ure of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instru ent was acknowledgeoefore me The fgrwing instrum t was acknowledgebefore me
this day of 20 by this day of 20 by
(Name of person acknowledging) (Name of person acknowledging)
(S gnatu4ofNotar y Public-State of Florida ) / (Signature of Notary Public-State of F orida )
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of IdentificType of Identifi n
Produced 4�(�. Produced
. NIELSEN
Commission No. �a, KAR(5@la� �� Commission No.
comm:ssion ,N FF 1 5(-537
My Con.:
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION""
Lt.: 1_WNGRf3VE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW-`'tiAtEylEW
DATE
RECEIVED
DATE
COMPLETED
lev. 7/2014