HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��7 1 • 17 Permit Number:
SCANNED
f BY
St. Lucie County E',r
Building Permit Application
Planning and Development Services MAY 15 2017
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie County, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial —Z)!5' Residential
PERMIT APPLICATION FOR:
PROPOSED HP NT LOCATION:
Address: 0(06t7 S US f{!NY
Legal Description:
Property Tax ID #: ��/ ! L% Sa j 50a 1 /(� p - q Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED D=SCRIPTI®N OF WOR :
skit
CONSTRU TIO21N INFORMATION:
A00itionaiworKtonepertormea unciert Is 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:
Cost of Construction:$ 0Q,040 Utilities: _Sewer _Septic Building Height:
OWNER/LE-SSEE:
CONIT, R:
Name: iL--
Name J� �^�
Address: (PC) S Ll5 6 r
Company:
City: L _ State: 0�C
Address: '76jS S "S 4+ 1
City: eS L State
Zip Code: 3 Y1 TL Fax:
Phone No.-7 7 X a! S` a(3 ]
Zip Code: —2 V11f C— Fax:
Phone No -;�X 70 9 Q-d(
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail
State or County License iL ! 16 (230
from the Owner listed above)
If value of construction Is 2500 or more, a RECORDED Notice of commencement is required.
'& TZ,f o k •2 Z
SUPPL@M€NTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip. Phone " '" "
City: State:
zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 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 dccessory 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 ontractor/License Holder
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY'Or ',
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this_ day of. 20_ by
this _ day of . 20_ by
(Name of person acknowledging)
(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 Identification
Type of Identification
Produced
Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING "
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETE D
Rev.7/2U14