HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETEu FOR APPLICATION
TO BE ACCEPTED
1 UV
Date: 1 ' ��
Permit Number:
i
By RECEIVED
k Bui
ding Permit Applicatio AP o 2 2018
Planning and Development Services
ST. Lucie County, Permitting
Building and Code Regulation Division,
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential 1/
PERMIT APPLICATION FOR:
PROPOSED fNPR®�lEMENT LQCA OI�1:
ddress:
Legal Description:
Wroperty Tax ID #: 1-°,O0*j7-00Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: _ Right Side:_ Left Side:
DETAf�LEd D �SCRfPTION OF W®RK;
As; KeA
COIRS STR+UGTION )NiORMAT(ON:
Additional wor to be pertormea under this permit
-check all that apply:
_Mechanical _ Gas Tank _ Gas
Piping _ Shutters Windows/Doors '
_ Electric. _ Plumbing _ Sprinklers
_ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
\ost of Construction: $ !/, 01pl Dy
Utilities: —Sewer Septic Building Height:
OWNER%LE�S�SEE
C(JNTRACT®R:
Name: Sfn% 1
Name
Address: %tjJ0 3 AVe_hr Ie--
Company: c ,
Address: 4. S-
City:161��i State:,&
Zip Code:,3 Fax:
City: IV& b, 9-�SD State
Phone No.�%',Z �,i� /P) v7D I
Zip Code: 3.2-9 5 S Fax:
E-Mail: C E r° 44, ,Ol eZ I
Phone No 569-15PD
Fill in fee simp a 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.
SUPPLEMNT CC?N� TRUCTIC�}N L EN l.A INFORMA 1a
DESIGNER/ENGINEER: _ Not (Applicable
MORTGAGE COMPANY: _ Not Applicable
'Name: ,
.. _.
m Nae:... .. .. -
Address:
Address:
City: State:
City: State:
Zip: Phone.
' I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: _ 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.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that iJgranting a permit will authorize the permit holder to build the subject structure
is in
which conflict with any applicable Home Owners 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.
Inconsideration 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 Florii a 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/ ee/Contractor as Agent
for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA L I - ^
STATE OF FLORIDA
COUNTY OF �`},�• ��, ,
COUNTY OF'
The forgoing instrLiment wa acknowledge efore
me
The forgoing instrument was acknowledged before me
this day of 20by
this day of 20_ by
(Name of per on acknowledgin )
(Name of person acknowledging)
(Signature of Notary Pubtic- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
t/
Personally Known OR Produced Identification
Type of Identification--
Type of Identification
Produced (.11
Produced
KAREN S.
gtipaF vye4n�
NIELSEN
Commission No. Coma( 21�
N FF 11 5637
Commission' No. (Seal)
My Co mmi
Sion Expires
June 1�2,
,��Flfl
2018
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