HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 6 Permit Number:
• ""� i RECEIVED
Building Permit Application JAN 1
Planning and Development Services 6 2018
Building and Code Regulation Division ST. Lucie County, Perm ittin
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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 lineIN
� s
Address:
Legal Description: P <C ODA " L06 7') &A
Property Tax ID#: 3 �- DOD 1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION
OF WORK: ,. .. ,
L t 5 C7
" 'Z' iAim '±' A
'AdMitiona work to be erformed under t ispermit-check a appy:
HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
.01lectric Plumbing Sprinklers ElGenerator 0 Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
c�ci
Cost of Construction: $ r Utilities: Ll_Sewer[]Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name E r3� A2(r_- !Vn Name: OpKd--fdr y )E14 c Pf -r C_ �C�
Address: �a� �Lt_&A)b ��L—4V!21- Company: ) eJll� C �
City: �,� .i�� t� L State:r(— Address: '03-S_ 040-44 4 #�f—
Zip Code:,1�19-_Z- Fax: City: Ke u c)v State:/::7L
Phone No. 57-1 t,-441 - Zip Code: 3:2 9 to Fax:
E-Mail: ��r � S f l/1,2K C �a:( Phone No. -7 ?Z ` 5 bZ - 6 Dyy
Fill'in fee simple Title Holder on next page(if different E-Mail: f ( /�`/
R
from the Owner listed above) State or County License: c 13OD(2 S 57-
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION-
DESIGN ER/E NGI NEER:
NFORMATION'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 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 ma t in yrsted
eying t for
improvement your prope ice of Commencement must be r r d and p on the j site
before the ' s nspection. I you inte d toobtain financing, co der or anrney befo e
comm ork or recor 'n our otice of Commencement-,—
of Owner/Lessee/Contractor a ent for Owner Sig ature of Co actor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The fppoing instru ent was acknowledge efore me The for g instru ent was acknowledg d before me
this S day of Sol—V 20LOby this�ay of u� 201X by
Name of person making statement Name of person making statement
Personally Known�OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type gf4dentificatron
PrQftced Prod e
I ' t
Aug LA
(Signature of Notary Public-State of Florida) (Signature of Notary Public-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
Rev.8/2/17