HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: - ULJQ
(—RECEIVED
Building Permit Application) MAY 01 2018
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 h
PERMIT APPLICATION FOR:
Address: I o 5- %o/VC/
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
I
DETAILED DESCRIPTION OF WORK:
.S P V 1=e �/J,B� ' /- /V.ec✓ //�I e2 f�e f�2 Zs/ / Ale-fl G�i6L�
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: $ 4000' Utilities: —Sewer —Septic Building Height:
Name' oar !CL40 i Name: & et
Address: /� S ,v r . Company:e ,
City: Aeiw State:Si Address: Y7 8' Zk' . Loaf; 1��
Zip Code: 3 �/�g Fax: City: Ron f 5jL, L[c Gem State:_2��(
Phone No. 7 9;L' 00/ �/� rf Zip Code: 3 y f'F9e Fax:IV
E-Mail: Phone No 19,-- Or-,C0$"r ?-c'l
Fill in fee simple Title Holder on next page ( if different E-Mail L J1,C C>rAM.0-11r Cf.
from the Owner listed above) State or County License ;L0
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
?PLEMENTAL CONSTRUCTION LIEN L
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/Lesseeitontractor as Agent for Owner Signature of Contractor/Li96n e Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledgl4pefore me The forgoing instrument was acknowledge efore me
this T day of 201A by this day ofMAY
, 20J& by
(Name of person acknowledging)� (Name of person acknowledging)
(Sign ture of Notary Public-State of Florida ) (Sign atu a off oiary Public-State of Florida)
Personally Known OR Produced Identification V/ Personally Known OR Produced Identification
Type of Identifi i Type of Identificat'
Produced— Produced
,= KAREN S. NIELSEN
B+
Commission No. c9�_�}�ssion#FF 115637 ommission No. - S NIELSEN
1� p isSion Expires a;? sion#
mn,•``
June 12, 201 ;°c::�_„F My corporis FF 115637
8 - ••� sion Ex
- J Pires
8
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANG
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
iev. 7/2014