HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: U ' _ Permit Number: I
RECEIVED
NOV 05 2018
Planning and DevelopmBuilding Permit Applicationent 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:
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Address:
Legal Description:
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Property Tax ID#: a Lb0 —Z D 5 O L k c� /� Lot No.
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Site Plan Name: Block No. \O
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pertor.med under this permit–check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric Plumbing —Sprinklers _Generator . Roof 3 Pitch
Total Sq. Ft of Construction: 3;1bn Sq.Ft.of First Floor:
Cost of Construction:$ ( SOCA' c� Utilities: —Sewer —Septic Building Height: Uv-_
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Name 5ht-76:1 l_(�7 Name:
Address:_/,2,;� (` Tl�'vrZ Company: r'PeEs;t6L-kj2 of . -Z(–
City: �?Lee� State:l7L Address:
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Zip Code: Fax: City: i-I? State: NL�.
Phone No. `l�Z ���– IL�Z, Zip Code: '�'f5t9'2_ Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License - O --7C-Z-g (
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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 record osted On the jobsite
before the first ins io o ' tend to obtain financing, consult with der ora attor fore
commencin or or cordin ur Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/Li e o er
ti
STATE OF FLORIDA � STATE OF FLORIDA
COUNTY OF COUNTY OF
The f rgoing instru ent was acknowledg-jbefore me The f rgoing instru e t was acknowledge efore me
this day of 2010 by. this d y of 20� by
4 i 011Ael
N.
(Name of persona owledging) (Name of person ac now edgin )
(Signature of Notary P7c-State of Florida) (Signature of Notary Public-State of Florida)
PersonallyKnown OR Produced Identification Personally Known OR Produced Identification
Y
Type of Identification Type of Identification
Produced Produced
;�"p YP�e� KAREN S. NIELSEN
"gin KAREN S. NIZSU
_: ��;State of Notar
Y P �I
Commission No. =_° ;State of FIorQBea�bCommission No. _ - ��g� Y Public
ommission #G :� = Commis-lon-4GG 207484
%', oFI ° My Commission Expires
MY Commission June 12 2
029
4.144
�ete�
REVIEWS FRONT ZONING PEO R PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev—.7/2014