HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4- Permit Number:
RECEIVED
' APR 2 5 20
Building Permit Application 18
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 V/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: `U35 Nor-4-h A1A ]:� )3. For+ Pl'er [' , FL 3`t ci L�
Legal Description:
Property Tax ID#: I LA (Y)12. i) a Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
LDETAILED DESCRIPTION OF WORK: '
rod, A
mvA L J oor
CONSTRUCTION INFORMATION Ez
b .. .
�A-ddltiona ork to be performed under this permit-checka appy:
M
VAC Gas Tank E]Gas Piping Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
�/"w C
Cost of Construction: $ (y oo Utilities: _Sewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
_—
Name C li C'y o i Name:
Address: 42-35 X D(+ %F 13 Company:
City: Fvrf Pf Pr Ct State:FL Address:
Zip Code: 3+-t11 L4 011 Fax: 1)r ,C City: St te:
Phone No. 177 -`-3`l - 5 `f 2)7 Zip Code: Fax:
E-Mail: C I 0 ChP����lge//51)0-"h•nPfi Phone No.
Fill in fee simple Title Holder on next page (if different E-Mail:
from the Owner listed above) 43a Stat or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. ^ '
S (,e M 2-30 v vCE 2h -�100 �-��r' m R-> `_Q�
I
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: of Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
Z 11
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.
I I T
'�h—L" Z_il 1"t-
Signature of O er/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF 1, L(iC C COUNTY OF
The f r oing instr ent wa acknowledge°�efore me The forgoing instrument was acknowledged before me
this day of 11 200 by this_day of 20_ by
1
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced �L �L,. Produced
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. Seal) mission No. (Seal)
r
KAREN S. NIELSEI
L__2
Commission s FF 1156 7
REVIEWS FRONTNS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17