HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE
EE7COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �'�� L1 Permit Number: \MF::�- CLOI
• RECEIVED
Building Permit Applicati n MAY 0 8 2018
Planning and Development Services
Building and Code Regulation Division 5T, Lwpie County, Permitting
1300 Virginia Avenue, Fort Pierce FL 34982 - -
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: V—
PROPO UN:
Address: � � � r
Legal Description: r
f2 ou
Property Tax ID#: J� J�' `� '"(.C.IJ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
ETAILED DESCRIPTION OF WORK:
e 1
CO
Additional work to be pertormed under this permit-check allilt at app y:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator Roof �)1 Pitch
Total Sq. Ft of Construction: a � &) Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer Septic Building Height:
01NNERp/L�SS1 CONTRAGl'OR
Name R in Lrflc(< Name:
Address: ' §V 4±-) f' Company:
City: v r 4- L✓�� State: Address: 54
Zip Code: Fax: City: ),OfZ� .\e rCe State:
Phone No. �7Z �U f CD �� �OC) Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License Coo a;j ` C)
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
[Sd'PP1'tM ENTAL CONSTRUCTION LINLAIN INFO TION:
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.
Sigh4iture of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA/ � 1 STATE OF FLORIDA
COUNTY OF . 7X , l 1 1C 1E_ COUNTY OF
The f oing instrument was acknowledged before me The f going instrument was acknowledge before me
this day of_�W� , 20 by this day of 20L by
�t�p►PJI l�'� 11,�rn�
(Name of person acknowledging) (Name of person acknowledging0 AA
)
I
(Signature of Notary Public-State of Florida) (Signature of Notary ublic-State of Florida) /
Personally Known OR Produced Identification Personally Known OR Produced Identification ✓
Type of Identific tion Type of Identific ti T
Produced L- Produced— V
K REN S. NIELSEN IELSEN
111111" a>t orida-Notary Public Commission No. KARE IN
l.
`�11PY PL// 11111111
Commission No. :P ��a;Statj )
Commission 8 GG 207 e8A .¢:,State of F ori a-Notary Public
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My commission Exp = Commission ft GG 2r074e84
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DATE
RECEIVED
DATE
COMPLETED
e)v. 7/2014