HomeMy WebLinkAboutBuilding Permit Application 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 theermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or an9covenants 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 your Notice of Commence e .
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Signature of Owner/Lessee/Contractor as Agent for Owner— Signature—of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Si7�1,,cie_ COUNTY OF
The f going instrument was acknowledged before me The forgoing instrument was acknowledged before me
this ft going
A25,%4_ 20 19 by this—day of 20 by
(Name of person acknowle4ing (Name of person acknowledging)
(Signature of Notary Public-State of Florida (Signature of Notary Public-State of Florida
Personally Known OR Produced Identification 7L Personally Known_OR Produced Identification
Type of Identification Type of Identification
Producedrcoe- K50,o SSIi--716 G-J roduced
Commission No. G& 026ATTHEW ADAM FALCO
{sea .Pubk-Stw*cdf WPM ommission No. (Seal)
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REVIEWS FRONT SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
lev.
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED {�
Date: I7 Permit Number: (JJ 7 V b ' 0 j)-h
RECEIVED
Building Permit Application AUG J 3 2017
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential _
PERMIT APPLICATION FOR: �/
11.2 ` L_vi '�Li
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Address: 3LO N
Legal Description: L4 lrzi -' v CS k L '- (�
Property Tax ID#: (�,j,� j1 j}iZl.��. ( (. _ Lot No.
Site Plan Name: LL L. L-10 Block No.
Project Name: Wit):. LA
Setbacks Front Back: Right Side: Left Side:
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Additional Work to be pe Orme un er this permit–check aPaappy:
Mechanical _Gas Tank _Gas Piping _Shutters _windows/Doors
V/Electric ,Plumbing _ Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
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Cost of Construction:$ �S Utilities: —Sewer Septic Building Height:
Name `� 7Name:
Address; w. h mpany: "
City: 10 a t s State:R, Address:
Zip Code:SIt_��_ Fax: City: State:
Phone No. (a l 7 a N 10 i Zip Code: Fax:
E-Mail: ^.oL rae. 13 ; ( . (.�►M Phone No
Fill in fee simple Title l olddr 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.