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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: C7 I J l Permit Number: ' RECEIVED Building Permit Application JUN 13 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 V PERMIT APPLICATION FOR: E'` l/ � PROPOSED INRROVEMEN LOCAKIN Address: b 7 y Legal Description: Property Tax ID#: (5[C) Lot No. Site Plan Name: Block No. Project Name: CO opef Setbacks Front Back: Right Side: Left Side: DETAILED DFS�R�I'P'TION OF W©R�K. Icr–Jt r« 6etv',cio cbo, r 9 e PeelAc 9 you cG,,, w(�h Ile CA/, COM STR�UC I'�NFOR�MATION: 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:$ �G G Utilities: —Sewer _Septic Building Height: OWNER/LE=-S�SEEI CONTRAt;TC+ R: Name ..__Co;,,-_ {� Name: Av' /+ r �� p , Address: Company: t/"c lc StateOId �+/City: Zip Code:( �'' ""Faz:`` City: �/i'do " Q,Oae State:FL, Phone No. 7 7a 3 7 S Zip Code: �� g(2rO Fax: E-Mail: Phone No 7 >a pp�� Fill in fee simple Title Holder on next page(if different E-Mail e q,%a, O f!-R;S Per- from eCfrom the Owner listed above) State or County License Cov-►¢ l so/S 33 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. 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 WWW recording our Notice of Commencement. 6 Signa re of Owner/Less Contractor as Agent for Owner Sig ure of Contrac icense Holder STATE OF FLORIDA STATE OF FLORIDA t COUNTY OF t 1C',1 F . COUNTY OF _ . UJCI The fo oing ins tr ment was acknowledged before me The for oing instr ment was acknowledge before me this I day of 20 by this day of 20 by 2�N17�►�t L�1`� I;� N►nn e L1116 Name of person making statement. `/ Name of person making statement. Personally Known OR Produced Identification V Personally Known OR Produced Identification Type of Identification Type of Identifi tion Produced VL Produced 1.., CJ-- (Signature of Notary - (Signature of Notary Public-State of Florida ) �•``aVP��•,, KAREN S. NIELSEN Commission No. ;'a`° °��;State of FI(ir�)Notary Public Commission No. ,,� YPoe�,, KAR NIELSEN =• •: Commission,# G� 207484 State of �a-Notary Public _• *= Commission.# GG 207484 OF My Commission Expires v a Mv Commission Expires im�`� June 12, 2022 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATI COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Te—v. 8/2/17