HomeMy WebLinkAboutBuilding Permit Application 02/08/2018 10:03 Lindquist Plumbing 7724811999 H0.382 #002
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �/4 Permit Number:
Building Permit Application
Planning and Developmenr5ervices
Building and Code Regulation Division ��� ZO��
2300 Virginia Avenue,Fort Pierce FC 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: _.0 SU'V10"I /6
Legal Description: 6 Z- i J :' AV 22, .S1° S r Z
Property Tax ID Lot No,
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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{ lona wor o e e orme un er t�•is permit—c ec aLJ Gas Tank []Gas Piping FI--•II Shutters Windows/Doors
t�I Electric L'KPlumbing Sprinklers E Generator D Roof Roof pitch
Total Sq. Ft of Construction: __.__. __. : Sq.Ft.of First Floor:
Cost of Construction:$ °,d f utilities:L]Sewer Septic Building Height:
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Name 'GCp Name:
Address: 0 By- IV-ll Compan
City: le'04t`r S 66 Stat Address: 0 tPo�}o
Zip Code: ?A Fax: City: ;,ti ew C.0 Stater°
Phone No. 7 _ .. _5J_ ,� 7 Zip Code: 3 ,
` Fax: �/r�q9
E-Mail: Phone No. !?(_o _—
fill in fee simple Title Holder on next page(if different E-Mail: [�
from the Owner listed above) State or County License:
if value of construction Is$2500 or more,a RECOItDED Notice of Commencement Is required.
02/08/2018 10:03 Lindquist Plumbing 77248II999 1,10.382 #003
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DESIGNER ENGINEER: •Not Applicable -MORTGAGE COMPANY; Not Applicable
Name: Name,
Address; Address:
City: State; City: State:
Zip; Phone Zip: Phone:
FEE SIMPLE TITLE HOWER: 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 permit.
St,Lucie County makes no representation that is granting a permit will authorize theormit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or an9covenants that may restrict or prohibit such
structure.Please consult with your Hume.Owners hsSucIZAIon 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 tollowing 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 Lo ariul.lier nor-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may restift in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the Jobsite
before the first inspeCl.iurl. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
Signature ofOWher/Eessee/Contractor as Agent for owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrume"as acknowledged before me
this—Z day of 20J_'-,J' by this.Z day of 20 1-�by
Name of person making statement Name of person ma ing statement
Personally Known Produced Identification Personally Known__-. / 11 Produced Identification
Type of Identification Type of identification
Produced Produced
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(Signaturco ak&4=WW i a2020 (Signature- f. Pub wW411,mb�.TA--,
F.YPIRES
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MY 0
Commission 0.0 4, CommIssio OMMISSION
--EXPIRESDwanber 20.2020
REVIEW5 FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17