HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I ' I� -17/ Permit Number:
RECEIVED
_ - Building Permit Applicatiori NOV 15 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: �� U
Pt: POSED N'.PROVE EENT LOCA I'aN.
Address: 10Co1�1 U S� V0 �wwc
Legal Description:
Property Tax ID#: J`7��' ��� l •t� ' 5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
QETAILED D.E�SCR�IPTtON a WORK.
Ad�F
CaNSTRUCTI p N INFOR�MA iON:
i11 ona wor to ape orme - un er t is permit-c M a 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:$ x,11 J Utilities: —Sewer _Septic Building Height:
OWN ER/L015E: SENIOR
Name' �-�`''�'�.' tis` 'S'--"'4 �n`a Name:
Address: gl� (� �'� Company: ac�oori Q�ti" .tar`e
Address: -t.:Sw ' V�. S�CitY State: Z
_
Zip Code: Fax: City: �U.scr- State: =V(-
Phone No. TA -L- S-A 9` GCI-13 Zip Code: -,V-kcK Fax:
E-Mail: Phone No T�11- 9$S- S I
Fill in fee simple Title Holder on next page(if different E-Mail 6'f\r UO h( �.r�2 ; �� ►���
from the Owner listed above) State or County License CJSC� G 0(0
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONS TRUCTION LIEN LAW 6 URMATIQN•
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 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,your Notice of Commencement.
Signature of Owner/Le -on ac or ams Agent for Owner Signature of Contra r/ icense Holder
STATE OF FLORIDA/''' ff STATE OF FLORIDA
COUNTY OF 1 11�� COUNTY OF
The for oing imnstrunt was acknowledge before me The for oing instrum nt�/as acknowledge before me
this day of 20_W by this g day of V 20& by
Name of persoi4 making statement. / Name of person malting statement.
Personally Known OR Produced Identification F/ Personally Known OR Produced Identification
Type of Identific ion Type of Identifi n n
Produced (r Produced
�--
• i i �
14 AA
(Signature of Notary Pub1'c- EN (Signature of Nota u +
S. NIELS
�,f�F��F„•- CKmFtE ry Public -,`;s�Po'% CAREN S. NIELSEN
Commission No. ;O^'�Y`6°<<;state of Florida#(3G 207484 '_� �`�=State of Flcri
r4�3aln 1f0S Commission No. Com diary Public
ota
missid '(�G 207484
irnission Exp '.;;�,F�„o�°� My Commission Expires
o� MY Con 2022
June 12,
June
REVIEWS FRO T ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE- -
COMPLETED
lev. 8/2/17