HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
Date: I O Permit Number:
�•� RECEIVED
Building Permit Application ,
MAY Ol 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie Cou ty, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: �� u
PROPOSED IN' T
Address: d 7U-3 4L��ilc�
Legal Description:
Property Tax ID#: ��I �9 'UQIp' OW , � Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAI ED DESCRIPTION OF WORK:
0 a ice TDA)
Additi0flal work toe per orme under this permit-check all that appy:
echanical _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: $ QCT Utilities: _Sewer _Septic Building Height:
Name L 144MC- Name:
Address: f K03 s47 fie'-?J 2 Company: w 's' r� Oct i�7
City: Fr 1/&,ce. State:/=G Address: 00b 9 (,ikeJ, C � y
Zip Code: 3`f`7Sl Fax: City: r---r17i61'_G e- State:
Phone No. Z Yv Zip Code: 3 c� /CS_� Fax:
E-Mail: CU/!hE'� o/7h y'//d /9' flat ( CUA Phone No (����
Fill in fee simple Title Holder on next page ( if different E-Mail ! /- e- Ccfli
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 recur ed and posted on the jobsite
before the first ins,�ecti n. If you intend to obtain financing, consult with le der or attorney before
commenc'n wor eiJording your 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 L E, COUNTY OF - L I ca
The fgrgoing instrument was acknowl edgecLbefore me The forgoing instrument was acknowledge efore me
this 1 day of y 20 by this J—day of 4!�,7 20Z by
(Name of person ack owledging) (Name of person acknowIledging)
' 1
(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 Identificat' n Type of IdentifiLaton
Produced L b L.. Produced V—L t)L,
Commission No. °"``°e`'' a ommission No. (Seal)
C mmi cN S. NIELSEN ion # FF 115G37
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My Commission Expires o1wrP
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;2018 .11 X114 -_ co n NtEL
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATI TLJikTCE.,,,,, s,rANG
COUNTER REVIEW REVIEW REVIEW REVIEW 12 13Wy
DATE
RECEIVED
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COMPLETED
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