HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLER APPLICATION TO BE ACCEPTED �!
Date: Permit Number:
z U
RECEIVED
St tt1de6XII110�
Building Permit Applicatio JUN 0 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 Resident)
PERMIT APPLICATION FOR:
Legal Description:
I"
�P�ioper�ty� Yax li®#: �� ® Lot No._�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DEED DESCRIPTI TAIL000011kW041RK:
CA) G YV F ACil�-
Aaamonai worK to oe perrormea unaer tnis permit - cnecK aii tnat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sorinklers Generator
%Mrtwa uction: �� OD
orb
�C f om-structioi : $
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
Windows/Doors
_ Roof 1'tc
Building Height:
01h1N ER%LE�StiSEE:
C®NTRACTiJR:
''a , e_W
ddress: S, e9 v � ��
Name:
Company:'
ity:�� State
ip Code: Fax:
Phone No. -:7 S-�6;71
-Address:
City: State:
Zip Code: Fax:
Phone No
--M 'Trl
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.
A ll
DESIGNER/ENGINEER:
Name:
_ Not Applicable
-.'Name::
MORTGAGE COMPANY: Not Applicable
—.
Address:
'Address:
City:
Zip: Phone
State:
City: State:
Zip" Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
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 prbhibit 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 ccincurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residehtial 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 your Notice of Commencement.
Sig natJ o . =caner/ see/ ontractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF - LUC���,
COUNTY OF
The foing instru ent was acknowledgebefore me
this. day of 20-M by
The forgoing instrument was acknowledged before me
this day 20_ by
of
(Name of per on acknowledging)
AA
(Name of person acknowledging )
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifi tion
Type of Identification
Produced
Produced
�. R S NIELSEN
Commission No. _ �'- stalte oESMRIL-Notary Public
Commission No. (Seal)
_' ' Commission # GG 207484
'�oFr�o4.� My Commission Ex 'res
June
, 2022
REVIEWS
FRONT
ZO I
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014