HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMI-'FETED, FOR APPLICATION TO BE ACCEPTE
Date: ,I Permit Number:
ra RECEIVED
Building Permit Applicatio MAR 2 3 2018
Planning and Development Services ST. Lucie County, Permittinq
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: 1 `
3
Legal Description:
;P[ipe'rtyTax l_D': �`i:L,L�' �J�J (�� �I,L, [ `� Lot No.
Site Plan Name: Block No.
i
Project Name: 1
Setbacks Front Back: Right Side: Left Side:
f�iLvl offin a .� • ` >•iii7 MI
Haamonai worK to oe perrormea unaer tnis permit— cneeK aii tnat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Numbing�l _ Sprinklers _ Generator Roof
ST; %511-, 'q 'Ft of,Constru,etion rt r lid Sq. Ft. of First Floor:
diMPO''E in-P� � Utilities: —Sewer —Se tic Building Height:
MOM NER/LEaSSEE:
CONTRACTOR:
Niame-,5 �" h'1 ql h
Name:
Address: 5 W �e %V
UO
Company:
City: Stater
��ip Code: / Fax:
Phone No. 001 6Q y
Address:
City: State:
Zip Code: Fax:
Phone No
l�Maih..
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State,or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
IN
SUPPLEMENTAL CONSTRUCT • lFEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable
MORTGAGE COMPANY: _ Not Applicable
N'ame::
Name:._.
Address: I
Address:
City: State: I
City: State:
Zip: Phone I
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address: I
City: 1
City:
Zip: Phone:
Zip: Phone: I
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 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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commenciniz woxk or recording-vour Notice of Commencement.
I
Signature of Owner/ ssee/Contractor as ' gent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Lii0,I
COUNTY OF
The for ping instrument wa acknowledg before me
�
The forgoing instrument was acknowledged before me
by
this day of ` r ` 204 by
this day of 20_
L`�1�Cllt � WYri� 1R1 ��
(Name of person acknowledging)
(Name of person acknowledging )
r `
(Signature of Notary Public- State ofI Florida)
(Signature of Notary Public- State of Florida )
e Identification
Personally Known OR Produced de
Personal) Known OR Produced Identification
Y
Type of ldentif1cat4on
��
Type of Identification
Produced — C _
Produced
KAREN S. NIELSEN
�ovO't�+++
Commission No. �= coinm(Sealp FF 115637
Commission No. (Seal)
- = My Commission Expires
y a,: June 12, 2018
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