HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLE rcv FOR APPLICATION TO BE ACCEPTED
Date: I I' I ' 1 SCANNED Permit Number:
BY
St. Lucie County
RI;dCEEVED
Building Permit Application NOV 17 2017
Planning and Development Services
Building and Code Regulation Division PER'AITTING
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie County, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential �Cl
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line I
Address:
=MENT
Pe�k
Legal Description: �(�" ��+ �L vUL(� Z jg(o Lk ( �o -]
PropertyTax ID #: 5Y[ r 0 000 _� 0 U O c� Lot No. 7
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:
Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: -
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CONSTRUCTION INFORMATION:
Adclitional Work to e orme under t-checkispermit a apply:
rn
gHVAC En Gas Tank []Gas Piping _ rJl
Shutters Q Windows/D--o�ors
DElectric 0 Plumbing 05prinklers I Generator 12 Roof 1 � Roof pitch
Total Sq. Ft of Construction: r/� D (� 5 Ft. of First Floor:
Cost of Construction: $ / ��� Utilities. CnSewer Septic Building Height: _
OWNER/LESSEE:
CONTRACTOR:
Name O , s 5ni; (l `i v d
Name: fJr/✓�
-
Address: 6,01 /� aa(h
Company: %
City: 6- State: '/7
Zip Code: 1 Fax: /�Y
Phone No. cZ' 6 IVW
Address: f1t- fi O
City,,Z-h Pyjell% State:
Zip Code: Fax: /U
Phone No. �� �%
E-Mail: (pjor�5$�cv�,Id,fSav� (� (ct/YIOuc�
Fill in fee simple Titl He older on next page (if different
from the Owner listed above)
E-Mail: (7 d o -
State or County License:
CCC/326If
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required:
A
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
Zip:
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 holderto 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 our Notice of Commencement.
SSi nature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOF
COUNTY OF • I I.L�'siG
The forgoing instrumentw acknowledged before me
The forgoing instrument was acknowledged before me
this rff—day 1 20by
this day of 20 by
of
ay-� &AL0►�
�h1 ICY r� rJ 1
Name 6f person making statement
Name f person making statement
Personally Known OR Produced Identification `/
Personally Known OR Produced Identification
Type of Iden4ifiGation
Type of Identifi ion
Produced
Produced
cr--�
(Signs f Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No.JiKAR�$h�) NIELSEN
Commission No. KAELSECommissionp
FF 115637-
CommissionoQw^o°'`
My Commission Expires
JUne
-
�"�+'A� My Commission Expires
12, 207 B
r d:
REVIEWS
FRONT _
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17