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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED h Date: 1V• • Permit Number: I D 1 1 r. IFM RECEIVED Building.Permit Applicat 11011 OCT 012018 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: I AYA �S—t-L� C C �. PR@POSHD IMPROVEMENT L0ANTil s' Address: S `� Legal Description: Property Tax ID#: I I lXJ ©©l 1� 3M ' Lot No. Site Plan Name: Block No. Project Name: -Setbacks Front Back: Right Side: Left Side: DET SLED DESCRIPTIONS WORK: f,C. IOV Z,Z, CO RU TIaN IRIFORMATIO'N: i 06—nal wor to ,e pe Orme un er.t is permit-cffe—ciZ-aY1 tat 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:'$ J� ©�Bf> Utilities: _Sewer _Septic Building Height: OER/LEvUWE, CONTRACTOR: Name ' t t'ry'� 4�f,S.(ice(=� Name: Address: ;J� .og �« Company: City:' T i�c_ a ;° State:- L Address:. . Zip Code: Fax: City, Lt Stater Phone No.= ! Zip.Code: E-Mail:- e,,A � !51a16/L CdWL Phone No 2Z(3j Fill in fee simple Title Holder on next page(if different E-Mail 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 C�NSTR�UCTI� LIEN LAW IN�FORMATION: 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 thepermit 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 an osted on the jobsite before the f irsl inspectio If you intend to obtain financing, consult wit nder attorn y before commencin ork or r c rdin our Notice of Commencement. Signature Owner Lessee Contractor as Agent for Owner Signatur of o ra STATE OF FLORIDA STATE O FLORIDA COUNTY OF COUNTY OF The fgrgoing instru nt was acknowledge before me The forgoing instr nt as acknowledge before me this day of 20 by this day of 20L by 1410-x. Rk) (two Name of person making star ement. / Name of person making statement. Personally Known OR Produced Identification .V Personally Known OR Produced Identification ✓ Type of Identific ' Type of Identifi n Produced Produced 1 (Signature of No (Signature of Notary Public-State of Florida) 1PRY P(,B� •KAREN S. NIELSEN s Commission No. ;:° ��- State of Flcri gd�p ary Ful Commission No. RE er Commission# G 207484 S. =±�FOFF�o� My Comrnission Expiros =State of Flo o;ida NIELSEN .- Notar ,� �F`oPc`� GG 207484 MY Com REVIEWS FRONT ZONING SUPERVISOR PLANS. VEG SEAJU GG REVIEWS OVE COUNTER REVIEW REVIEW REVIEW REVIEW W DATE RECEIVED DATE COMPLETED Rev. 8/2/17