HomeMy WebLinkAboutBuilding Permit Application Y
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �� +
Datedo'- c-r+ _ Permit Number: I I
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Building Permit Application OCT 3 12017
Planning and Development Services PERMITTIN
Building and Code Regulation Division St. Lucie C nt•.,, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
?PROPOSED IMPROVEMENT LOCATION:
Address: iA o C I. c l% V'C1`C+ SAGa-t'� i C
Legal Description: \ 61zy-C S1 p ft_.Ac' 4 LO co
Property Tax ID#: z �� (� �(W C3 Z; - Lot No. (AD _
Site Plan Name: 0.,Lk Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WOR
4e "&<Jc C-�
CONSTRUCTION INFORMATIONM
Add itional wo rk to be ner o rFned un er th is permit-check a I I appy:
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
FlElectric ❑ Plumbing FISDrinklers Generator XRoof Roof pitch
Total Sq. Ft of Construction S . Ft.of First Floor:
Cost of Construction:$ ��( Utilities:11 Sewer O Septic Building Height:
OWI ER/LE SEES=
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Name Name:
Address: -- — Company:
City: 1of3{ <A, State:Qt Address:�+{'C�,�'iVLQ
Zip Code:3�t"[ j Fax t- lC� City: �)& K t11 � ►C : Stater
Phone Zip Code: 33�r iI — Fax: ���
E-Mail: At"W_Q_ PhoneNo.
Fill in fee simple Title Holder on next page ( if different E-Mail 'L3.
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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DESIGNER ENGINEER:
/ Not Applicable— pp 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 thepermit 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
cornmencing work oCPecording your Notice of Commencement.
;,,gnatu of Owner/Lessee/Co gent for Owner Sign=OF
ontractor/License H er
TE OF FLORIDA STORIDA
COUNTY OF \Q, OUNTY OF
The forgoing instrument was acknowledged before me The for ung instrument was acknowledged before me
this ay of�.��� 20� by this?Z ay of 20n by
Name of person making statement Name oferson making statement
Personally Known�OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Nota � SRI LOVITT (Signature of Notary P �'R IE LOVITT
Commission No. _` :`= MY COMK4SBON#GG143436 Commission No. = MY CoMtNWN#GG143436
EXPIRES September 17,2021 "^?a;;.,:' EXPIRES September 17,2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17