HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ;LA Permit Number:
RECEIVED
FEB 21. 2018
Building Permit Applicatio
Planning and Development Services ST. Lucie Coun_ PrfffllIR�
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 f /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential I/
PERMIT APPLICATION FOR:
LPROPOSED INPROVEMENT LOCATI - N:
Address: 22�[
Legal Description: iwj
Property Tax ID#: , 900- 1 Lot No.
Site Plan Name: Block No.
Project Name: ek_c4rt(6 'e oxo
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
t� ffis ro w a y) .*
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit—check all that appy:
—Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
vElectric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
�v
Cost of Construction: $ C) — Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name KwpO Name:
Address: Company:
city: P , elffac State: Address:
Zip Code: Fax: City: State:
Phone No. — nn 7 9 Zip Code: Fax:
E-Mail: P_V4 V F MSS• Co 1q Phone No
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 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 y pAr property. A Notice of Commencement must be recorded and posted on the jobsite
before the first i pe ion. If ou intend to obtain financing, consult with lender or an attorney before
commencingw rk ing y--obf Notice of Commencement.
Signature of wner/Lessee/Contra o as Agent for Owner Signature of Contractor/License Holder
STATE O FLORIDA STATE OF FLORIDA
COUN OF S�� L V �� COUNTY OF
The forg ing instrumer}t was acknowledgej before me The forgoing instrument was acknowledged before me
this a� d �
ay of �-&` 20 by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pub -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 Identification
Produced �r- L illt,
Produced
DANA Itui'vi`-�S
1~ '` �ISSION#G 022023
Commission No ' ' 4 OMtJpeg )1,2020 Commission No. (Seal)
ded h ru 110'1'/public Unuetw+to
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014