HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `
Date: CC-, Permit Number:
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Building Permit Applicati
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:
PROPOSED INPROVEMENI, LOCATION.,
Address:
Legal Description:
RECEIVEp
APR 16 2018
S7'. Lucie coun,y, Ara��TlIk�IR
Commercial Residential_
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name: ig asl
Setbacks Front Back: Right Side: Left Side:
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CONSTRUCTION lNFORMATICN
Additional work to be performed un er t is permit - check , all that apply:
'_Mechanical _ Gas Tank —Gas Piping —Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator Roof _4-/,�z Pitch
Total Sq. Ft of Construction: �j Sq. Ft. of First Floor:
,00 '
Cost of Construction: $ -5. 00 d Utilities: —Sewer —Septic Building Height-'
,OWNER/LESSEE.
CONTRACTOR:
Name f? �R
Name:
Address: cj V o\ vex
Company:
City: �-} �I efC.& State:
Address:
City: State:
Zip Code: Fax:
Phone No. 7�2 ✓mod �° �� l SDY,
Zip Code: Fax:
E-Mail:
Phone No
Fill in fee simple 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.
SUPPLEMENTAL CC?NSTRUCTION ItEN L/�W INFORMATION
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
Cit I V 11State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name: 141
Address: 4
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: 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 vour Notice of Commencement.
01/
Signature of wner/ Lessee/Contracto Agent for Owner
STATE OF FLORIDA
COUNTY OF
The forgoing instr ent was acknowledg before me
this Lro day of 20 by
M'19 kitj 02E'�=u ,
(Name of p son acknxledging p ^
(Signature of Notary Pubic- State of Florida )
Personally Known OR Produced Identification iv
Type of Identi4cavon
Produced I<AREN S. NIELSEN
con mission it FF 115637
My Commission Expires
Commission No. =:�, .d � CF@@o 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
Type of Identification
Produced
Commission No. ,2,_ a (Seal)
REVIEWS I COUONTER NT ROEVI NING W I SUPERVISREVIEWOR I REV EW NS VEGETEVIEWON S EV EWLE I EVIWVE
DATE
RECEIVED
DATE
COMPLETED