HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INF�O/ MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3SCANNED p Permit Number:
NJ �: (i� RECEIVED
Building Permit Application
MAR 0 b 2018
Planning and Development Services ST. Lwc1Q County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential _
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end'of line �('l� � --) I
Address: q 7 Q 33 S - W"`cU4yL K-tAfe& Vak R- Ku
Legal Description: Gwl+ L 42,, I r 3 6
Property Tax ID #:
Site Plan Name:
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Project Name: YAAuk -A&A� V\Am
Setbacks Front Back: 2- 01 Right Side: Q-0 t Left Side: 4 81
Lot No.
Block No.
Aaditional work to be performed- under this permit— checK an apply:
C�HVAC El'Gas Tank ❑Gas Piping _ Shutters ;Windows/Doors
Electric 15-1 Plumbing []Sprinklers Generator ;Roof Roof pitch
Total Sq. Ft of Construction: 217,'0 S . Ft. of First Floor:
`C W�
Cost of Construction: $ I) l 0 Utilities: _ Sewer Septic Building Height:
4+fi M1ut' ��r� - �:� n -
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CONTRACTOtR�=
Name 1 PIM(ICK
i`M
Name:
Address: 4 363 S
1 J_ �L'-eM Q>Z
Company:
Address:
City: 7_6n..i p,-lesCR Stater
Zip Code: 3 K
_
Fax ( °J�
City: State:
Phone No. b
5�4
Zip Code; Fax:
E-Mail:
Phone No.
Fill in fee simple Title Holder
on next page (if different
E-Mail:
from the Owner listed
bove)
State or County License:
If value of construction is :�csuu or more, a KCwKucu 11JUMC LY1
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SUPPLEMENTAL#CONSTRUCTIONfLIEN
LAWiFIN1=0tMATION F'
4-:�
- ENnIN ER:
Not Applicable
MORTGAGE�COMPANY:
Not Applicable
Name: - �
Name:
_
Address: i ci
WU j
Address:
City:
State: PU
City:
State:
Zip: 34t% Phone Rol -
3 Tb- qU';
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
_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 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' pectio If you intend to obtain financing, consult with lender or an attorney before
commencing,ork or rec�rding your Notice of Commencement.
Signature of Ow
STATE 6F+'(ORIDA
COUNTY OF ii /'
as Agent for Owner
The forgoing instrument was acknowledge before me
this day of MAEL , 204 by -
' Name of person making statement
Personally Known OR Produced Identification
Type of Identificatio
Produced L
(Signature of Notary Publi
KAREN S. NIELSEN
Commission No. 94 C(Seal)ssion # FF 115637
o�c My Commission Expires
June 12, 2018
REVIEWS I FRONT
COUNTER
DATE
RECEIVED
DATE
.COMPLETED
Rev. 8/2/17
ZONING I SUPERVISOR
REVIEW REVIEW
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of , 20_ by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
No.
(Seal)
E VPNS Ef!/ I VEGETATIEVI WON I SEATURTREV EWLE I MREVIEWVE