HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION, TO BE ACCEPTED
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Date: ��N..I'ermit Number: 1 r
i BY RECEIVED
StLucie �;ountr
FEB 21 2018
F Building; Permit AppliL
gn
cie County, Permitr
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 i
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: s1�
PROPC�SED,INPROUEMENT LOCATI►OIN.
Address: S O-) (%1 Li r+ I e P► e rCC�1 L 34
cl YZ
Legal Description:'_Y�OCA � An P" 4 er �'S+'4 k3 Lxr) � - 0 � - 81 V, C-00 Lofs
Property Tax lD #: 9 (o ()1 ' d 313 " 000
Site Plan Name:
Project Name: n
Setbacks Front lX Back: Right Side: Left Side
A& (3
'CONSTRU.CTlON .1N:F.ORMAl'lON....
Lot No._
Block No.
Additional work to be pertormed under this permit - check an that apply:
i
_Mechanical _ Gas Tank _ Gas Piping —Shutters _ Windows/Doors
Electric _ Plumbing _Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: O _ Sq. Ft. of First Floor:
Cost of Construction: $ .,'t '� Utilities: —Sewer —Septic Building Height:
• 1 ri,��T
OWNER/LESSEE'"�jr,�°
CONTRAtlj CTOR: tl
Name f
Name:
Address: 1(Y1`1iAA-P_ Or,
Company:
City: e_rC9-- _State:
Address:
Zip Code: 3LA9I o Fax: `1T1 $9- �D�
City: State:
Phone No. �l"1 a - �% )" 155)
Zip Code: Fax:
E-Mail: Lj rj 91 \X_k\S6LA6 n-ej
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
147
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CtONL:: NeLSUPPLEMANSRUCAWNRV
aAT[ON
_
DESIGNER/ENGINEER: I— Not Appllcable,yr;
MORTGAGE COMPANY: Not Applicable
Name: ,, • r _ I %y,.''Name:
_
Address: I ....... ' -�-��'
� Address•
,i,��
City: I State:
City: State:
Zip: Phone' I `
I,
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: I Address:
City: I City:
Zip: Phone: Zip: Phone:
I
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 Home
conflict with any applicable 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 your. Notice of Commencement.
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Sig ture of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA 1
STATE OF FLORIDA
� '
COUNTY OF .JCS
COUNTY OF
The for instru
ping efl re me
s acknowledgIrby
this day of 20
The forgoing instrument was acknowledged before me
day
this of 20_ by
(Name of person acknowledging)
i
ct=
(Name of person acknowledging)
(Signature of Notary Pu lic- State of Florida) I
(Signature of Not Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
uced
��o4pxc nve� KARENii S. NIELSEN
Commission No. '; )-*2eeCflmmissiion S FF 115
omission No. (Seal)
a„ or My Com ission Expi
June
es
12, 2018
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