HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONh
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Q: In Permit Number: q I �r Q "A Ot n
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Building Permit Application DEC 15 2017
Planning and Development Services PERMUTING
Building and Code Regulation Division St. Lucie ounty, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address
Legal Description:
.9
Property Tax ID #: lEnt - W 2_-QW . a W -5_ Lot No.
Site Plan Name:
Project Name:
Setbacks Front- Back: �� Right Side,: Left Side: 1 z
ona
WE
_Mechanical _ Gas Tank _ Gas Piping
✓ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 40 , 000
Na
Block No.
all that apply:
_Shutters ZWndows/Doors
_ Generator \,-Roof Pitch
Sq. Ft. of First Floor:.
Utilities: —Sewer —Septic Building Height: a�
Address:LQ00.5 1�CS 0 101M 'k.
City: 5)r4 Ili e rc-Q- State: FL
Zip Code: 3 qQ S ) Fax:
Phone No. ' 5(DI-IYo)-7�-0gQ(0
E-Mail: baYv-=A+-iVV(!!-0ciA-Vo ni-N-
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:
Company:
Address:
City: State:
Zip Code:
Phone No
E-Mail
State or County License
Fax:
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name:_
Address:
City:
Zip:
Phon
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
UCTlaN ���N
Not Applicable
State:
_Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:'
Address:
City: State:.
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 dolhereby 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 your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owne'
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF A. LuC,(�.
COUNTY OF
The for ing instr ment was acknowledged efore me
this day of 204 by
The forgoing instrument was acknowledged before me
this day of 20_ by
.
nn A 34 1
(Name of person acknowledging)
.J---�
(Name of person acknowledging)
(Signature of Notary Public- State of Florida) 1
(Signature of Notary Public- State of Florida )
Personally Kno wn OR Produced Identification 1
Personal) Known OR Produced Identification
Y
Type of Identification
Type of Identification
Produced KAREN S. NIE'LSEN
roduced
Z Commission # FF 115637
Commission No. 0,89jommission Expires
''-;;��F�•a•�
ommission No. (Seal)
June 12, 2018
REVIEWS
FRONT
ZONING
SUPERVISOR
PLAN
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIE
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
I
DATE
j
COMPLETED
Te—v.7/2014