HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLi'i cii FOR APPLICATION TO BE ACCEPTED
Date: �• -1' Permit Number:
Planning and Development Services
Building and Code Regulation Division'
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
SCANNED
Build n�UP pr;nimb
g ermllt Applicatio
RECEIVED
MAR 0 9 2018
ST. Lucie County,
Commercial Residential
nPR`OPOSED ItVPROVEMENT LOCATION
Address: Z r r /'i iLi vP � . �. r �; ,� _ C- • 3 `� l� �/ i
Legal Description:
Property Tax ID #: Lot No.
1
Site Plan Name: a 'JzX V:,e I Block No.
Project Name: J>2i'ye
Setbacks Front Back: Right Side: Left Side:
1 CONSTRUCTION INFORMATION
Additions workto a per orme . ~ uncier t is permit - ch ec 'a tat app y:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing — Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: ! 0 Sq, Ft. of First Floor: . 1 G/ d d
Cost of Construction: $ 11. f ®o , b a utilities: Sewer _ Septic Building Height:
OIIUN ER/LESS:EE:
CONTRACTOR, a
Name L
Name:
Address: Zi-r Al pFrr)'i
Company:
City: i}t P: r✓c ti State:-L
Address:
Zip Code: 3 N 5 y 9 Fax:
City: State:
Phone No. 7 -7 7- 13 e 3
Zip Code: Fax:
E-Mail: ✓h 4 c M o o _ ZOO-
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail .
from the Owner listed above)
State or County License
It value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
-K
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
E
City: State: 1
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
i
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 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:.roorn 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 vour,Notice-of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The f rgoing instrument vqps acknowledge before me
this day of WW& 20 by
��66N wo , M1 W �
(Name of person acknowledging) ;
(Signature of Notary Public -State of Florida )
Personally Known OR Produced Identification ✓
Type of lclent14cgion KAREN S. NIELSEi
Produced , ,aY
Commission A FF 115G
=4 "- MY Commission [xpir
Commission No. r•'lf�'�� ''(Seal)June 12. 2018
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 acknowledging)
(Signature of Notary Public -.State of Florida )
Personally Known OR Produced Identification .
Tv e of Identification
mission No. (Seal)
REVIEWS FRONT j ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER, REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATER/L//4
COMPLETED
A