HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO
MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Numb
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Building Permit Application OCT 04 2018
Planning and Development Services ��s 19i= k°iisLA D,:`✓1' rtment
Building and Code Regulation Division � -
2300 Virginia Avenue,Fort Pierce FL 34982 E!C I is f i l)/ L
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOS`,ED IMPROVEMENT LOCATION
Address: /
Legal Description: �Jf9ul RX,4e 101�;L 2:2 L,,
Property Tax ID#: ( 00 Lot No. /
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
J- 77
DETAILED DESCRIPTION b`-WORK
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CO'NSl'RUCTIQN INFORMATIONkl
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Additional work to be performed un er t is permit-c ec all that appy:
_HVAC _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ c?_?QQ . 0 O Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE ;, :' CONTRACTOR:,
Name Name: i 2
Address: � (2_�/d,,.L /? ig7w / SF Company: lS
City:arlit"d k�s State: Address: I&-) Sw /j7 i Il k ire ff�P
Zip Code: 5/2Q�_ Fax: — City:6o it SY. State: FL
Phone No. 7,z� J; Zip Code:I S3 Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: d 00. Cd w,
from the Owner listed above) State or Cvounty License: o?&SY-3
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
UPPLEMENTAL°CONSTRUCTION�LI`EN LAW INFORMATION
DE ER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Phone:
FEE SIMPLE TITLE HOLDER: _No le BONDING COMPANY: _Not Applicable
Name: a
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
WNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicate
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 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.
Signa re of Owner/Lessee Contractor as Agent for Owner Siqe5k6re of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 61. COUNTY OF CIS
The forgoing instri.7i t as acknowledge¢kefore me The f r oing instr ent yvas acknowledgepefore me
this Pt—day of 204' by this day of 20,& by
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1!!1'1 ALA Q)F—"7
Name of person making statement / Name of person king statement /
Personally Known OR Produced Identification t/ Personally Known OR Produced Identification ✓
Type of Identification Type of Identification
Produced Produced
1
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(Signature c (Signature of Nota I rida
`O11YP'F�, KAREN S. NIELS,EN
%\),%�P�i,,, KAREN
..� &MI
Commission ,2 os State of Florida-Ngrglublic Commission No. �2° e�°State of Fio ELSEN
_ _ion # GG 20 484 :N ._ tart'Public
Commission
%SOF Ft �� My Commission Expires ;�, Qa, on #GG 207484
June 12, 2022 '�.,�� °�. My Commission Expires
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IL
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17