HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: �0 )— 0 nT�
_. RECEIVED
m,. .. _ Building Permit Application
JAN - 3 2018
Planning and Development Services
Building and Code Regulation Division permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 st. Lucie county
Phone: (772) 462-1553 Fax: (772)462-1578 Commercial Residential _
PERMIT APPLICATION FOR: �a� -�-c�(-
PROPOSED INPROVEMENT LOCATION:p
Address: � 1 ho
Legal Description:
Property Tax ID#: 2 ylyS703002 9-000 9 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
I DETAILED DESCRIPTION OF WORK: ff
CONSTRUCTION INFORMATION:
Additional work to e per o-f rme�c u tis permit�ecc a t at app y:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric �! Plumbing _Sprinklers _Generator _gRoof Pitch
Total Sq. Ft of Construction: 7 IR 17 Sq. Ft. of First Floor:
Cost of Construction: $ R0i� Utilities: _Sewer _Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Name: 0 / G G
Address: s c Svj ;00 Company: Tey J� /��
City: c a { State:L Address: 97� SC /As
Zip Code: 3�4 FT Fax: City: 'Sl. State:
Phone No. Zip Code: ,3 9 5B3 Fax:
E-Mail: Phone No 2- X52
Fill in fee simple Title Holder on next page ( if different E-Mail �� /��� Nlf
from the Owner listed above) State or County License tr'�C /�(Z� 3-2
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:
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 recordin our Notice of Commencement.
-:Jl ♦HOi'-
Signatu eof Owner/Lessee/Contractor as Agent for Own a ure of Contractor/License Holder
STATE OF FLORI e S TE OF FLORID
COUNTY OF a m C UNTY OF ��<
The forgoing inst Pajent was acknowledged fore me F crr, fo going instr t was acknowledged bef
i�
thday of 20 / by s day of 20�by a
'(
1 �—L _ °'T '�-C o I LLG
Name of person making statement. V
�` �§&me of person making statement.
Personally Known OR Produced Identification Tonally Known OR Produced Identification
Type of Identifi ati Type of Identi
Produced r - .&c-. Produced
( ignature of N a y Public-State of Florida (Signature of Nota ublic-State of Florida )
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.