HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: nn)A-4 DD Permit Number:
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tw� -- RECEIVED
Building Permit Application MAY 0 2 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982 eJ N o J —
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:g3 L[}OL� V-�s� SAA I L / (�/�( 7 ?G, _
Legal Description: �� ir+ 7 t-u, (E ell A 3 2 5-
Property
Property Tax ID#: _ �. `<UU Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: ` n
CONSTRUCTION INFORMATION:
Additio,Kal work toe pertormed under this permit-check all appy:
HVAC 0 Gas Tank ❑Gas Piping _Shutters a Windows/Doors
11 Electric ❑ Plumbing U Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ U u Utilities: Sewer El Septic Building Height:
OWN ER/LESSEE: CONTRACTOR:
Name �)A 4 , !�� �AJAJ ,Q Name: t-14 - i iAp r
Address: V Company: CuL,9 'MEJJ AI'V1_
City: :2 A _�ICI) .J State: � Address: 6 23 Al &a 4 / /-"u
Zip Code: Fax: City: ��,/J_T _Tt4..)C,(1Z Stater
Phone No. <',(G `. G�U +y�iel 5 Zip Code: 44 Fax: /—
E-Mail: � ,�C_ 1J OR ��Zv Phone No. ��� ( ( els-{
Fill in fee simple Title Holder on next page(if different E-Mail: 2 IJOL><ZIA-2�.2u I I v
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 recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencinR work or recording our Notice of Commencement.
I
Signature of Owner/Lessee/Contractor as Agent for Owner Signatu a of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA �� �IE,
COUNTY OF ,� �)(.,I r_ COUNTY OF
The f oing instrument was acknowledge before me The forgoing instrument was acknowledged before me
this day of 20by this-2:_day of 20X by
Vo u4n gi `:2 r \)a Cy-At:-1
Name of person making statement Name of person making statement /
Personally Known OR Produced Identification V1 Personally Known OR Produced Identification V
Type of Identifica ion Type of IdentifiWion
Produced Produced I
I
LLAA
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. k," KA R E N(Sed#1 E L 5 E N Commission No. —
.�,a.,�o�,,, KAR
Lh _ Cornri ss on x F� t 15Ei37 �1 Comm NIELSEN
S u 5&37
My r umn ss,on Expires �„ FF 11
u June 12, 2018 v C';n ,'rission Expires
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17