HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED d
Date: Permit Number:
J.L „� RECEIVED
Building Permit Application JAN 2 4 2018
Planning and Development Services ST, Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: �o� , `
PROPOSED INPRO��V// �E��MENT LOCATION:
Address: Jy� �.�`"l406( S,-,4'v-F 1 L/&
Legal Description:
Property Tax ID#: 3��5 '1 ��� OaO � 0�4 -� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: �Y�l
cr-IY7 i) S Ids
CONSTRUCTION INFORMATION:
Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _ Plumbing _Sprinklers _Generator ✓Roof /d- Pitch
Total Sq. Ft of Construction: 50 � f Sq. Ft. of First Floor: �)-0y O
Cost of Construction: $ Uc�U f Utilities: —Sewer —Septic Building Height: 1 U
OWNER/LESSEE: CONTRACTOR:
Name J1 Name: --y
Address: 3D 11, Company: rye o
City: - S L , State: Address:
Zip Code: Fax: City: `^ Stater
Phone No. —07 Zip Code: Fax:
E-Mail: Phone No, — D
Fill in fee simple Title Holder on next page ( if different E-Mail rcc� �26"-za , (-/I
-
from the Owner listed above) State or County License C<.G
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, consu nder or an attorney before
commenci or recording our Notice of Commencement.
Signature f wner/Lessee/Contractor as Agent for Owner SignaturFFLORIDA
tractor/License Holder
STAT F FLORIDA STATE
COU OF S L UC `� COLINS'� L wz
The for oing instrument was acknowledged before me The forgoing instrument was acknowledge before me
this'-'k'"\ day of 'U4\ 20� by thisday ofsa-r\ 20NA by
i),r n-�'horiy i1 r\-•lnory � < a�c �C'
(Name of person acknowledging) (Name of persona nowledging)
(Signature of Notar ublic-State of Florida) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identific - I
Produced �L ID L Produced L :' ` ''• DEANNA MARIE GIVENS I
---- e d E MY COMMISSION#GG 022023
Cb DEANNA MARIE GIVEN.. -'' XPIRES:
Commission No. �s M1���IISSION#GG 022023 Commission No. r4Decer
I EXPIRES:Decemoer 16,2020 Thru Notary
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