HomeMy WebLinkAboutBuilding Permit Application 1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I
Building Permit Application '! NOV 2 0 2017
Planning and Development Services
Building and Code Regulation Division PERN1II NIG
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie Co ty, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 'St 2��1� ��" 0�� S�. L'vca� T�=l
Legal Description: fj��.e�ke.�r a �.v�e f C�`t, ��a 'CS%CK k `� le'ia\' � � �Od
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Property TaxID -7(;i - O0C3`� -0�6-- ) Lot No.
Site Plan Name: Block No.
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Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�Q 000 �a :�y ��®, "�; w� �., i5:�e�xr� (a\►�a� .
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CONSTRUCTION INFORMATION:
Additional work to be nertormed
- under this permit-check all apply:
E1HVAC Gas Tank ❑Gas Piping _Shutters I ❑Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ i l`�-®CSC). t�� Utilities:0 Sewer 0Septic Buiilding Height:
OWNER/LESSEE. CONTRACTOR: it
Name )L Name: A
Address:i<,35 SG 1-%,CXc( Company:T- al �c .l�iA.�C \�cxA \�� r♦!(-
City: 2t SN "C_,� !f State: \ Address: t Sly
Zip Code: Fax: City: Stater
Phone No. 50 a 71>s__�- 4 6`a of Zip Code: ���'�C� ,Fax:
E-Mail: MT v 2 Phone No. `Y-1 ' "t C)S T
Fill in fee simple Title Holder on next page(if different E-Mail: ock-C C U'at*00.C ai'n
from the Owner listed above) State or County License: hic-,C,
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW IMPORMATIO.N
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: 1 _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 restriction's 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 m'ay 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 '1,�
COUNTY OF Mo •� 1(�, COUNTY OF
it
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 4 t day of OU!) hA�' ,20�by this-tq+ of J)rj],ft kd( I 20 by
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Pro li duced Identification
Type of Identification Type of Identification
Produced, ) D(. l_ ja. Producedi 1 C.
6MI'
(Signature of Notary Public-State of Florida Signature of Notary Public-State,jof Florida
i , ' CAROL A.PREW 9t0a'Ot'env see dX8`wuaoo AW
Commission No. a (S aI C mmission No. 1=600
o �otAry Publk,State of Florl a our d'
= Commisslon#FF 149300 Epuo�to etetS'ollcInd i0910N *'v F
=! My comm.expires Aug.10,22018 M3Hd'V 10HV3
REVIEWS FRONT MZONING � SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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