HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ��CSo�'d55�o
• 2018
• Building Permit ApplicV:REC:EIVED
ty, PermittingPlanning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential !/
PERMIT APPLICATION FOR:
PROPOS /t
Address: e Wl Ce,
Legal Description:
Property Tax ID#: 0 n Q t - Ooo -t Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: _ Left Side:
DETAILED DESCRIPTION OF WORK:
Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
_Electric _ Plumbing _Sprinklers _Generator Y Roof 3/17- Pitch
Total sq. Ft of Construction: J/ Sq. Ft. of First Floor:
Cost of Construction: $ 00 Utilities: Sewer —Septic Building Height:
Name i nn - Name: O (�
Address:��Z Ft S Company: O
City:f4;"'eA-6'0__ Stater Address:2 (o A C_ A✓�
Zip Code:elf u5` Fax: City:T �r D1-erGz,. State:
Phone No'2,;$3 ,7/Ab-.33 -2-(o Zip Code: 3�-¢L.�' Fax:
E-Mail: Phone No S
Fill in fee simple Title Holder on next page ( if different E-Mail ` vl
from the Owner listed above) State or County License C� 3`Z 7.2 4
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: I
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 insp ction. If you intend to obtain financing, consult with lender or an attorney before
commencing/work r record in our Notice Commencement.
Signat a ner/Lessee/Contractor as A ent for Owner ?SATE
ure of Contractor/License H der
STATE FLOR A + ` OF FLORI /� '�^_QQ ,
COUNTY OF �1;�.,� ^�— COUNTY OFX�n/ty� -�
The for oing instr ent was acknowledge before me The for oing instrum t was ackngwledged before me
this day of 20 by this day of 201 by
Name 6f person mak g statement. Name of p rson making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification -nn Type of Identification
Produced Qhl l' Produced IDl Jo-f.i
Kimbe M. ,,�� y.�!/ Kimberlyn M. Garwood
(SignatuF¢-o: n Q? lorida) (Sig etu f lori
x'. . Expires:January 16,2Q2 ';';�.... ,_ '
Uary
Commissio6C. Bonded Ihni Aamn mogry (Seal) Comm fro. Bonded t ru Aaron Notary (Seal)
GCS 1lsgs7' GU i-15zt 7--z-
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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