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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date:�1�,' '_ Permit Number: rt, - RECEIVED sF - • Building Permit Application JUN 14 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 PERMIT APPLICATION FOR: V PR4VON-ED b NOTA @MENT LOCATICf.N: Address: 5oo Legal Description: ,Property Tax ID#: 13c1 — (.IOC623 =Ooo Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back:. Right Side: Left Side: ):i)fTAIaED DwRf um qF WORK: (��o��� �.59 -t-o� �4�r�c e�►�;f�lv�1�,� Sysfe.�t Trc.v► l"( sear 2.S 1 ori CQ STR�UCTIO NF©RMATION: AaditionalworKtobepertormed under tis permit-CheCK all that appy: _Mechanical Gas Tank. _Gas Piping _Shutters _Windows/Doors' _Electric _Plumbing _Sprinklers _Generator -Roof Pitch Total-Sq. Ft of Constructiiom , , Sq. Ft. of First— Cost of Construction:$ �SC90 Utilities: _Sewer _Septic Building Height: OW SER/LF--S�SEE: CONTRAtOR: Name .- Lar", .'e. "ert,, Address :b:0 �r R�• Company 'U:S i,i:(�'h �'� ►'1C City:.""�:'i9ri a State:FL Address: ���/5`. . •St1' $;;w �Q State: Phone No. NA Zip Code: .3 y9 S 3 Fax: E-Mail: 44A Phone'No 772"3 A3: "''36 " Fill in fee simple Title Holder on next page(.if different E-Mail I-uSr} a` OUf106(1,:CUw, from the Owner listed above) State or County License of C If value of construction is 2500 or more,a RECORDED Notice ommencement is required. S~UP#'LEMENITUMC©NST' CTION LEEN LAW I`NF®'RMATIQI : 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 wor r cording our Notice of Commencement. Signature of Owner/Lessee/Cra tor•as gent for Owner Signature o ntractr/License Holder STATE OF FLORIDA STATE OF FLORID COUNTY OF COUNTY OF The fo�r oing instr ment was acknowledged before me The forgoing instent was acknowledged before me this.1 l day of 204 by this day of r 20j7 by �m r CoLL I WJCo LL (Name of person ac owledging) (Name of person ackno ledging) ,VL, 0,i-A i (Signature of Notary Public-State of Florida ) (Signature of Notaryic-ub State of Florida) Personally Known OR Produced Identification V/ Personally Known OR Produced Identification Type of Identifica ' n Type of Identificat n Produced L Producedit IrTt `.otpara�e�� ;_ KAREN S, NIELSEN p�PpYP,,B, KAREN S. NIELSEN �.State'ot Commission`No. _�° I�,Stat4Soa�i)orida-Notary Public Commission No. Co MA Notary public Commission #GG 207484' o, mmi.sion +r Pte` � My Co"Missi GG•207484 ,,�FOF ��°.• My Commission Expires jut v 1 ­2022 �; on Expires REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE " MAN , COUNTER REVIEW -REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED: DATE COMPLETED Teiv--. 7/2-014