HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �(
Date:�� 'oZ.rJ• Permit Number: I U
..�, .__- RECEIVED
Building Permit Application JUN 2 5 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: To Select from dropbox, click arrow at the end of line
,PROPOSED IMPROVEMENT LOCATION:
Address: 151 UA 'R>A 24
Legal Description: O(,i)JM ILL V11_LJ 4-- C AnLVSre-k ,Z
Property Tax ID#: U()nZ o2 ` o2�V l Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�i1?LAC.E EAmE Ful �;M6 .310,1) � lb,v S-� £� wc� tolv0 14 6A r-
CONSTRUCTION INFORMATION:
Addition or to e orme under tispermit-checka appy:
WVAC L_I Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
11Electric ❑Plumbing ]Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ �/ o ' Utilities:n Sewer❑Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name IM omzv 01 to S S go Name: lC IAL VCA
Address: Company: GSE ,k me4q A.c-. Ill'
City: State: - Address:
Zip Code: 149.5r q Fax: 3c City: n State: 4
Phone No. (2 Zip Code: A49 933 Fax: X
E-Mail: Phone No. -
Fill in fee simple Title Holder on next page(if different E-Mail: ? V064-01 1 &Q 0_ r4 MA(L o G'2ir-i
from the Owner listed above) State or County License:sA C o �J
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
commencin work or recorling your Notice of Commencement.
Signatur o ner Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDALFII STATE OF FLORIDA
COUNTY OF A- LU(s,lF_ COUNTY OF tA•L
The forgoing instru ent was acknowledge before me The forgoing instr ent was acknowledge before me
this day of 20j L by day of 0 , by
Name of person making statement / Name of person making statement
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced L Produced
..�
(Signature of Notary Public-State of Florida) (Signature of Notary KAREN S. NI ELSEN
�� 4, Public
Commission No.lFi
KAREN e%l NIELSEN Commission No. ?_��" �c';SC m F.dkilotery
ate of Flo:idb-P:otary Public _ _ Commcf ix( GG 207484
Commission# GG 207484 ;�, a My cornmISSion Expires
2022My Commission ExpiresOwl-
June 12,REVIEWS ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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