HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: �o�' i' 1 Permit.Number: )1la:0060
•RECEIVED
Building Permit Application DEC 0 `, 2017
Planning and Development Services
Building and Code Regulation Division PER "f 117ING
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie COUnty, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential _ c�
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address:
Legal Description: L- 1•
Property Tax ID #: J - - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front 1 �� Back: Right Side: 26 Left Side:
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,Electric Plumbing ❑Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ c1h
"Shutters
OGenerator
Windows/Doors
Roof Roof pitch
S Ft. of First Floor:
UtilitiesCnSewerW_Septic Building Height:
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«OWNER%L,ESSE�• r r.,�"` ; '
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-CONTRACT
Name
Name:
Addre s:•Haga Sl,l�xe r.oY.
City: OC\ S� lAC P, .State: �
Compa '.
Add ss: -
Zip Code: Fax:
C' S State:
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Phone No. ��a f(0-��j`1
Zip C de: Fax:
E-Mail: (�\66CA (��p i�,.� l t�Q�\. (�,�n
Ph ne No.
Fill in fee simple Title Holder on next page ( if different
E-Mail:
from the Owner listed above)
State Count cerise:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requires.
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SUPPLEMENTAL CONSTRUCTION
LIEN LAW INFORMATION
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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:
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 recordina vour Notice of Commencement.
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Signature of Uw-ner/Lesselff
ontractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF s j (',I _ COUNTY OF
The forgoing instr ment was acknowledged efore me
this � day of 20 Uby
(Name of person acknowledging)
(Signature of Notary Public- State of Florida ) , /
Personally Known OR Produced dentification
Type of Identification Produced Pl.' [) I-
Commission No.
Revised 07/15/2014
The forgoing instrument was acknowledged before me
this day of , 20 by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
(S@KAREN S. NIELSE 10 mission No.
$ mission N FF t 156
My Commission Expir s
(Seal)
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