HomeMy WebLinkAboutBuilding Permit Application 1
All APPLICABLE INFO MUST BE COMPLETE FOR APPLICATION TO BE ACCEPTED,,
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Date: Permit Number:
RECEIVED
Building Permit Application SEP 2 6 2017
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982 i
Phone: (772)462-1553 Fax. ( 7 )7 2 462-1578 Commercial Residential
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PERMIT APPLICATION FOR:
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I, PROPOSED IN �ROUEME'Nl' LOCATION.
Address: /OBI NE c�i��/sf.0✓I QhKS DrIV�
Legal Description:
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Property Tax ID#: ✓/ ��� � � �-7 Lot No.
Site Plan Name: I Block No.
Project Name: Lot,i t tl
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Setbacks Front_ Back: 3ZO Right Side: 0 Left Side: !qS
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CO:NSTRIUC IOV I I NRO'RIMA 10'N;
Additional work to be pertormed under this permit-check all that apply: I1
_Mechanical X6as 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:$ »� Utilities: _Sewer Septic Building Height:
ow !ER/I_Ess� coNTRA.
Name Name`. J1P 6-C/S may.., ;. -..
Address: _/ /1J�'.. ,CGIy Sit �a�S �•' Company: >`0�"1'da
City: �sL State: —C Address: /b/3--D Shev �f
Zip Code: 3 C083 Fax: l City: I State:
Phone No. -i-i2z• -2k5 " �" U I Zip Code: i Fax:
E-Mail: Phone No 7 %—//2-7 1
Fill in fee simple Title Holder on next page (if different E-Mail �44(G.
from the Owner listed above) State or County LiLicense �
If value of construction is 2500 or more,a RECORDED Notice of Commencement is re i uired.
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S,_ �F��LENIENTP►L CO'N51'R�I•C�TIO•N LIE<N LAW IN'FORMATIO�N..• -
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address:-.•• Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLEJITLE 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 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 cor ' our Notice of Commencement.
Signature ci Owner essee Contractor as Agent for Owner Signature of Contrac or License Holder
g / / g g /
STATE OF FLORIDAy, - STATE C F FLORID
COUNT OF L� •�U'C� COUNTY OF
The Lgrgoing instrL&ent was acknowledged before me The f rgoing instr ment as acknowledged before me
this day of 20 I by this day of 2q_q by
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(Name of person acknowledging (Name of person acknowledging)
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(Signature of Notar Pub ic-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known Personally Known OR Produced Identification
"""' KAREN S. NIELSEN Type of Identi ica ion KAREN S. NIELSEN
Type of Identifion ,,� Qy,�B-,,-
Produced _ Commission# FF 115637 Produced '0��,"r
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'° mission # FF 11 5637
a My ommission Expires W
";� �� 2018 My Commission Expires
Commission No. °i���d'� a 2. Commission No. 4SeQJ)12. 2 8
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW. REVIEW REVIEW
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