HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ax - iR S(;ANNW Permit Number:
Planning and Development Services 1.
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Legal Description:
RECEIVED
Building Permit ApplicatiLnFEB212018
ST,kputy� cn
Permitting
El1lIENT (0 "1 I"0'
Commercial Residential
Property Tax ID #: Lot No,
Site Plan Name: Block No.
Project Name: ROW
Setbacks Front Back: Right Side: Left Side:
DETAII.0 NkRIPTION OF WORK �� e
_ _ !� 1 _ ! rf. _ a `�� 6, _ _ r7 1 i . e--1
CONSTRUCTION INFORMATION
Add itio ..wor c to be pertormed under this permit — cheCK all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors
/02
Electric _ Plumbing _ Sprinklers _ Generator ,,—Roof cV1 Pitch
Total Sq. Ft of Construction: nn ���1l�,�� Sq. Ft. of First Floor:
Cost of Construction: $ � () Utilities: —Sewer _Septic Building Height:
QWNERLESSEE: ;9 ,:
' CONTRACTOR:
Name re ergs U
Name:
Address:
Company:
City 17��i�e� State.
Address:
Zip Code: c3g9YO Fax:
City: State:
Phone No. o:?
Zip Code: Fax:
E-Mail:
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.
DESIGNER/ENGINEER: _ Not Applicable
-Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER_ _ Not Applicable
Name: '
Address:
City:
Zip: Phone:
COMPANY: _ Not Applicable
ame:
ddress:
ity: State:
1p: 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 Irules, 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 unc
accessory structures, swimming pools, fences, walls, signs, scree
WARNING TO OWNER: Your failure to Record a Notice
improvements to your property. A Notice of Commel
before the first inspection. If you intend to obtain fin
commencing work or recording your Notice of Comrr
rgoing a full -concurrency review: room additions,
1 rooms and accessory' uses to another non-residential use
)f Commencement may result in your paying twice for
cement must be recorded and posted on the jobsite
ncing, consult with lender or an attorney before
mcement.
Owner/ Lessee/CodFactor Agent for Owner
Signature Contractor/License Holder
Signature of as
of
STATE OF FLORIDA
STATE OF FLORIDA .
COUNTY OF
COUNTY OF
The forgoing instrumen was acknowledg before me
day 20M, by
The forgoing instrument was acknowledged before me
day 20_ by
this of
this of
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification �/ I
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
`�\ KAREI•NIEISEN
Commission No. :'_° `�= Commi:l ego 4 FF
Commission No. (Seal)
11
My Commission Expires
oFi`o�,�:
REVIEWS
FRONT
ZONING
SUPERVIS R
PLANS
EGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEWREVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
- /
/6
COMPLETED
Rev. 7/2014