HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 /)
Date: 1 �� 1 Permit Number:,
RECEIVED
Building Permit APplicati n
JAN 19 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie county, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: ,/ U r' S
Legal Description: -3 4(Q 7"— �� �00,:2- — GOOProperty Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Additional work o be pertormed under this permit–check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof a1� Pitch
Total Sq. Ft of Construction: ( -700 Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height: �a
Name Gt �j ��� /�@ �- Name:
Addre/sJ� f'�GGCO7 Company:
City: coat' t. LVC I 'e State:_ Address:
Zip Code: p Fax: moi, City: State:�4 r
Phone No. 7 0 7 / 0 Zip Code: Fax:
E-Mail: r Phone No 7 --NI-03
Fill in fee simple Title Holder on next page (if different E-Mail 2 UD /l
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Not Applicable7Nm
AGE COMPANY: _Not Applicable
Name: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 recording o Notice of Commencement.
Signatur f Owner/Lessee/ContrK4
Agent for Owner Sig ature of ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF In COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledgebefore me
this� ay of _ 204by this1�y of 20 by
Y171—
(Name person acknowl ing ✓ V (Name of rson acknowledging)
(Signat f Notary,Pub/State of Florida) (Signature o o r�%OR`
Publicat of Florida)
Personal) Known v OR Produced Identification Personal) Known Produced Identification
Type of Identification nnrytt Stephen P.Frederick Type of Identification Stephen P.FredR cfc
Produced NOTARY PUBLIC Produced NOTARY PUBLIC
fUllft f-STATE OF FLORIDA STATE OF FLORIDA
Commission No. %��WCornrn#GMW93 Commission No. GG048393
Expires 1/27/2021 9 . xpires 1/27/2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.