HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 113 Permit Number: 0
- RECEIVED
Building Permit Application
JAN - 3 2018
Planning and Development Services
Building and Code Regulation DivisionPermltr+n9Department
2300 Virginia Avenue,Fort Pierce FL 34982 St.Lucie Cqu�CY
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:
Legal Description:
Property Tax ID#: 1,3?1 • LU®)` ®CL,53' 1 e Lot No.
Site Plan Name: Block No??
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION"OF WORK:
h. FleG-7 4ri".111k U"
C !at/ti�er^
,�e c r -� � �'u,ll overs •
CONSTRUCTION INFORMATION.
Additional work to be e orme un er this permit—check all appy:
11HVAC as Tank ❑Gas Piping _Shutters Q Windows/Doors
11 ElectricL_J Plumbing E]Sprinklers E]Generator E]Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer O Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Im (,� Name: Ig-4-'ed eAN
'r
Address• 'W I WCORM-11ompany:
City: State. Address:
Zip Code: ax: City: State:
Phone No. ,0Zip Code:
E-Mail: Phone No. S
Fill in fee simple Title Holder on next page(if different E-Mail: G�
from the owner listed above) State or County License: (� D
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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 TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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
co,onnim<ing work or reco_cdiagyour Notice of Commencement.
- s
SignatLi6e of Owner/Les /Contractor as Agent for Owner Signature of ontra or/Licens older
STATE OF FLO - STATE OF FLOR,DA
COUNTY OF�11,6 i e , COUNTY OF�(�l�C/L
The fo oing instru nt was acknowledged efore me The for oing instru ent was acknowledged fore me
this.y day of 20j by this T day of 20 by
'*,10NO 12,1N
AP�0& - V
( m o p rson acknow edging) (Nam f person ac nowle ging)
CKr \
P(sin of Notary u �c-State of'Florid ignature of Notary PAilic tate of Florida)
tifica on
Personally Known enti ica
R Produced Idtion Personally Know Produced Idencap
';�yZr�..Ygroouce
oic,; t18ERT1`*iH <r"�'O - RNA.KING
MY COMMISSION# G $s0838 •,.�';; MY COMMISSION# ��638
Commission fgES:'Mayg�'l Commission N y
;,,,, PP; IRES:May 2021
°:,p �tRp�. Bonded Thru Notary Pubfic Undewdem ',,,��,t°• Bonded Thru Notary Public Underwritem
Revised 07/15/2014
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INITIALS