HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLEi r_6 FOR APPLICATION TO BE ACCEPTED -
Date: • �-�"1' Permit Number:
RECEIVED
G.
i . vg Permit Application MAR 2 9 2018
Planning and Development Services ST. Lucie County, Permitt(ng
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:
Address: q 196 1; S .le< Kiin, 16 e2P. �-_L 3 91
Legal Description:
Property Tax ID #: on 3 I o"1 C I Obi a. C�ca-CD�• Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Righ',t Side: Left Side:
Haaitionai worK to oe perrormea unaer finis permit " cnecK au tnat apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Spri klers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: :70D Sq. Ft. of First Floor: �r22>
Cost of Construction: $ .3006 Utilities: .—Sewer _Vteptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
MVrtzL_ Lanen4 P
Name:
Address:, 016 o S� F—. II
Company:
City: State:lfL
Address:
Zip Code: Fax: I
City: State:
Phone No.Q35a" 11
Zip Code: Fax:
E-Mail : C c>' �" -
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above) I
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address: I _
Address:
City: State:
City::. State:
Zip: Phone
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: I. 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.
Iced prior to the issuance of a permit.
I certify that no work or installation has com2sners
St. Lucie County makes no representation thais granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owne Is 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 our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Ag i nt for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged blefore me
The forgoing instrument was acknowledged before me
this day of �� 20i by
this day of 20_ by
(Name of person acknowledging)
(Name of person acknowledging )
�e
(Signature of otary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Ide tification
Personally Known OR Produced Identification
Type of Identificc ''on r
Type of Identification
Produced �— 1, I
Produced
,• S. NIELSEN
Commission No. o�;.""°°B.•.• S FF 115637
Commission No. (Seal)
Cloreion
My mmission Expires
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