HomeMy WebLinkAboutBuilding Permit Application All APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Y"(
Date: �� Permit Number: 1� O 9
EC
'
SEP 2 8 2017
Building Permit Application PERMITTING
Planning and Development Services St.Lucie County,FL .
BGilding and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: .
PRf POSED 1NPRC+}UEME T LOCAT0N:
Address: f ✓�- ,
Legal Description:
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Property Tax ID#: 2 I ' �d)5• _C(DO!ti 0M' I Lot No.
Site Plan Name: Block No.
Pro ject Name:
setbacks Front_ Back: Right Side: Left Side:
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DETA LED DE� RPTtON F WORK:
Yn
4/ st,��It OF Y—z
MCON W TR+UCT'fON 1NFORMA ION:
Additional work to be pertormed under this permit-checR all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters 'V Windows/Doors
—Electric _Plumbing _Sprinklers _Generator Roof. Pitch
Ti tal Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ �� Utilities: —Sewer _Septic. _ Building Height:
OWN DRf LE=�S�SEE: CONTRA OR:
Name C.li�.0 Name:
(Address: 7 C>/(` EC f�l 6�'U�S 'Company:
!City: State: Address:
_.
Zip Code: Fax: 1 City: State:
Phone No` 01 l Zip Code: Fax:
E-Mail: \ f Phone No
Fill in f e simpl Title Holder on next age(if different E-Mail
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from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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S�U'PPL N A�@N' J��TION° 11EN LAU1/ Nt��d iIUTAT QN:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA `� STATE OF FLORIDA
.COUNTY OF , COUNTY OF
The f oing instru ent w s acknowledged efore me The forgoing instrument was acknowledged before me
this day of 20by this day of 20_ by
Nanie of person making statement. / Name of person making statement.
Personally Known OR Produced Identification "' Personally Known OR Produced Identification
Type of Identipation Type of Identification
Produced. QL Produced
��---�
(Signat re of Notary Public-State of Florida) Signature of Notary Public-State of Florida)
�, r �1EN S. NIELSEN
Commission No. :;.•' C mmission No. (Seal)
,. om fission.# FF 115637
-• �'- My Commission Expires
"+ 2 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED o2
DATE
COMPLETED
Rev. 8/2/17