HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1 i
�y RECEIVED
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Building Permit Appy cat on ; FEB 16 2018
Permitting D partment
Planning and Development Services St. Luc' County
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial I Residential
PtRMIT APPLICATION FOR:
PR k�P1�SED IN�R;ROUEME�NT L®C,4TI'ON.
Address:
lei rbc, ECt _ �5
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Legal Description:
Property Tax ID#: � �' 605-03 -CON
Lot No.
Site Plan Name: E. Block No.
Project Name:
Setbacks Front Back: Right Side: Left Sidel:
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DETAILED DES11kili ®N OF-1N®•RK;
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cc,0ms1 Al101.,, INFOR11,4TI'ON: „ i
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fAdditional work to be performed under tis permit-check all that appy:
echanical =Gas Tank _Gas Piping _Shutter) _Windows/Doors
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_Electric _Plumbing _Sprinklers _Generator Roof
fiTotal Sq. Ft of Construction: l "� Sq. Ft.of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic ' Building Height:
ODUU�NE'RJLESSEE .�r . 0 , .. .,n CONTRACTOR: : f 0,11 ,4WIT113_0'15411�i
Name WILWANP Name: T Y R; ,mw s
Address: Company:. U-�-
City: 'C pib( State:�'1_- Ad'dre'ss-l`
Zip Code: I Fax: City. " JT Psi ; State: L
�In a:-
Phone No. 0-10 79'46lZ Zip Code: 'Fax:
E-Mail: Phone No (M) 5-^Z069
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Fill in fee simple Title Holder on next page (if different E-Mail
6�25
from the Owner listed above) State or County i'icense,' ELI1
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required;'*
- StJ�' PLEME 1`,AL CONS RUCTIdN LIEN LAIN I•NFC1R`Mfi►T[O,N:
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 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 ou oti a of Commencement.
Signature of Owner/OWAgUnt Signature of Con 11
a r/Lic nse Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF Z.kt,,C�, COUNTY OFA
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thismg day of Teb 20__NJq by this KD day of e_� 2011L_ by
(Name&p on a cnowledging) (Name of e n a nowledging)
(Sig ure of Notary Public-State of Florida) (Signa ure of Notary Public-Sta a of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification \'
Type of Identification Type of Identification
Produced -. A Produced
N Inull?N g6nojgi PaPU08 •.������,,,.. _ ak "
Commission No. J E47LLl J� # { p� �a� a: Commission No.
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COUNTER REVIEW REVIEW REVIEW . REVIEW EWA z REVEIN
DATE -
RECEIVED
DATE
COMPLETED
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