HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -�
Date: 77 Permit Number:___�.��• r]�„•�
4/ 'o RECEIVED
- Building Permit Application NOV 2017
Planning and Development Services Public Worlis:
Building and Code Regulation Division St. Lucie Coyrty, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
IRR Q t•7SE0 INP• OVENFELNi LOCA I(I
Address: I ( CotX )rte, -C)� )p
Legal Description:
I
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
I, e
Df�'AILED DE�SCRIPTIDN QF WORK:
�0' STRUCTION IN�CIR,M (ON:
Additional work to be pertormed un er t is permit-check all that appy:
_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:$ 1 nnn Utilities: _Sewer _Septic Building Height:
Name C h r-o' Name:
Address: 1-1 N • rn,02ema lL)2 Company:
City: PST Ll�lC 1-P Stater Address:
Zip Code: Fax: City: State:
Phone No. 9SCO L+C_Ys • W e-311 Zip Code: Fax:
E-Mail: 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.
Sl1'PP'LEMENTAL C®NS ��ICTf�Ri LI£N L./�" I �C�?RtIUTATIAN:
DESIGNER ENGINEER: _Not Applicable MORTGAGE COMPANY:' _Not Applicable
Name: Name:
Address: Address:
City: Stater City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE,TITLE,HO,LDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: ,, z • 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
commenicing work pr recordingam�your Notice of Commencement.
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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 4 • J"mG/ ( • COUNTY OF
The forwing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thi day of Al 2011 by this day of 20_ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Ide i i Type of Identification
Produced d Produced
(Signature of N ry Public-State o Y' - �RR Notary )
o< A .; 13.HUt�1PHR_Y(Sign�ture of Nota Public-State of Florida
tr: MY c0\4.11SSI0N#FF 1 4772 '
Commission No. ix•., Q #) EXPIAES:Narch6, 0 ssion No. (Seal) .
-jr r...�•o�,.
51
Bonded T,i
uu Nota�,Public Un an r�
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
04A
DATE
RECEIVED
DATE
COMPLETED
ev. 8/2 17