HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
Date: T�•��' �(� Permit Number: 4in -m
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OCT 1 k, 16
Building Permit Application
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Planning and Development Services Lucie i Unty,
5i. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential y
PERMIT APPLICATION FOR: E:WE i NIS C IVUL
PROPOSED INPROVEMENT LC►CATIQN k,.. o
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Address: g�� QE 14N\j LN F0 Vl QiEiLCE; i ��.- 34-q
Legal Description:
Property Tax ID#: f'� } �° 1 '" 000 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF WORK r e
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CO:IVSTRl1CTIOIV INFORMATION l Eh
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Additionalwork to be pertormed un er ME permit–_cFe–ck a I I that appy:
_Mechanical —Gas Tank —Gas Piping',. Shutters _Windows/Doors
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—Electric —Plumbing —Sprinklers) Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 2Q Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE CONTRACTOR x
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Name FiL%r6E (LtU E R-WAoi 0&-Z ..° ... : 'Name: '
Address: 09110 PIrNI,*4 Company:;
City: FO a,i P i mc-E State:- =L Address
Zip Code: 16rq� k Fax: City: State:
Phone No. "(0 600 S 142 VIAZip Code: Fax:
E-Mail: �tr� e �•y�e�'^�'v'��'7 �``� 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.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INI*ORMATIOfV w
. . .
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone 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 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 recordingNour Notice of Commencement.
Signatu wner/:Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA. STATE OF FLORIDA
COUNTY OF IV Loc COUNTY OF
The for oing instr ent wa acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 by this day of 20_ by
�: ' LeLl n Lank Mai ez
(Name of person acknowledging) (Name of person acknowledging)
(Signat a 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 """ KAREN S. IELSEN' `
M1'Rf I�
Commission# F 7 1 3
,__
C r res No. (Seal)
Commission No. -v My Commissi n ares
June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/201