HomeMy WebLinkAboutBuilding Permit Application ALL APPLIC BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: _ "
RECEIVED
Building Permit Application APR 3 0 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
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
PROPOSED IMPROVEMENT LOCATION:
Address: /C/q u , 1/l5+T1 C-f
Legal Description:
Property Tax lD#: Z,-10-4 3)a 00/s 000 ) -ot No.
Site Plan Name: : ,ock No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
(fid 0 0 b 0� s 14&-(P-s Cl- -+D-A C C9
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit-check a appy:
HVAC 11 Gas Tank Gas Piping _Shutters Windows/Doors
11 Electric F1 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ ZOo Utilities:0—Sewer F]Septic Building He;
OWNE�R�1/LESSEE: CONTRACTOR:
Name r\0(��c� UC^C�G` S Name:
Address: /`ge, L_4. V 131-r- Company:
City: -T1U'fi pie CC-Q_ State:'E Address:
Zip Code: ' `Hl 1-1-3 Fax: City: State:
Phone No. 208 vZip Code: Fax:
E-Mail: S�c��. h�✓� �9�cY.G.\ . c� 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: _,No.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
commer)cing work or recording our Notice of Commencement.
G
Silghature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF4. COUNTY OF
The orgoing instrwas acknowledged,before me The forgoing instrument was acknowledged before me
this ment day of 20Z by this day of 20_ by
Name of per7lnwking statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
e___ 1 4"/'L4 `Q) . k � -,, J 1'��
( ign ture of Notary Public-State of Florida) (Signature of Notary Public-State of Ficr;ca ;
Commission No. Commission No. (Seal)
KAREN S. NIELSEN
Commission# FF 1
June 12. 2016
REVIEWS FR — PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17