HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �() I
Date: Permit Number:
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CEIVED
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Building Permit Applicati 19 2018
Planning and Development Services ounty, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772)462-1578 Commercial Residential r/
PERMIT APPLICATION FOR: �,v/K- v wy ,r „� ` ��� yjvv.2 � �� � /�vfL
PROPOSED INPROVEMENT LO
Address: 1'6;-' 2- 7-If ` ,
Legal Description: -3 316, 4 0 PI-WI-4 Al-4.1 Cole Av N 330 S�
Property Tax ID #: -3 N U "3/ Dy `Z ��t' 7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DED DESCRIPTION OF WORK:
j-
AID 5, _2
c o.
CONSTRUCTION INFORMATIO
Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
Electric _ Plumbing _Sprinklers _Generator _ Roof Pitch
Total Sq. Ft of Construction: 2 i7-e_> Sq. Ft. of First Floor:
Cost of Construction: $ -55 PV v c7 Utilities: —Sewer —Septic Building Height:
OWN
Name ✓1y�2'�� 'iTlfL /J//1r��YLGIil�L(,i�r�' Name:
Address: / ��S �� /�i'�E�L /f✓r- Company: LL
City: State: 6 Address: 3 3,73 ti� yJZ/yi`�Z�/r r7 L
Zip Code: �y`14_3 Fax: City:a S7 •� L-� State: e-
Phone No. 772- -Z e2 f! -2066 Zip Code: f?7 Fax:
E-Mail: (,4,i144-/y} &sy S r64 _4; 4 U Phone No 772 ' Z Z `1 �yi/d
Fill in fee simple Title Holder on next page ( if different E-Mail �,yS r/fL 'P&X S /-4-
from the Owner listed above) State or County License w
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW IN MU
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 recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA- STATE OF FLORID
COUNTY OF COUNTY OF
The forgoing instr ment was acknowledged u
efore me The orgoing ins ment was acknowledged before me
this day of 20_]Z by this day o 20j- by
Name of person making statement. Name of person making statemen .
Personally KnowPt OR Produced Identification Personally Know" OR Produced Identification
Type of Identification Type of Identification
Prod ed Produced
(Sig atuAe of Notary Public-Sta . f Florida t5igfy6tdre of Notary Public-Stateta Florida )
.. .. --i..r.:..'':.
Commission No. "aya''% (Seal) INGRAM
ES ) Commission No. (Seal)
,•r. « Notary State of Florida
i
e Mr COMM. xpire per,20,2 8 „�..„
REVIEWS FR uy, SUPERVI SflIR ; PLANS VEATURILE ;'� ;AN ROVE
COU R R REVIEW REVIEW E ,o� °R�1/IEW,;, . EW
DATE ', """' Bo dedthrouFF 17 249
RECEIVED rygss
DATE
COMPLETED
Rev. 8/2/17