HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLE ED FOR APPLICATION TO BE ACCEPTED
Date: \ ��a \ Permit Number:
RECEIVED
BL ilding Permit Application FEB 2 6 2018
Planning and Development Services ST. Lucie Count Permitting
Building and Code Regulation Division y 9
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462- 578 Commercial Residential 10�\
PERMIT APPLICATION FOR: Plun bing
PROPOSED IMPROVEMENT LOUTION:
Address: RS \ a
3�1�
Legal Description: 'Ar
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Property Tax ID#: 1 - \ - - Q�I -ko Lot No.
Site Plan Name: block No.
Project Name:
Setbacks Front Back: Right Side: _ Left Side:
DETAILED DESCRIPTION OF WO K:
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CONSTRUCTION INFORMATION:
Additionalworkt0
flas
orme un mr t is perit-c ec a appy:
HVAC Tank E]Gas Piping _Shutters a Windows/Doors
Electric 0 Plumbing l_..J Sprinklers a Generator Roof Roof pitch
Total Sq.Ft of Construction: Sq Ft.of First Floor:
Cost of Construction:$ `L7 Utilities:0 Sewer 0 Septic Building Height:
OW N ERAESSEE: CONTRACTOR:
Name -Y i \L. Name
Address:-.a1 -k�S "I�LICompany:" r \
City: 4tate: 'i7 Address:An51 rr\c.r
Zip Code: ;�.N\ 5 Fax: City: p State: e�
Phone No. Zip Code:y4_1C1_ 4 Fax:
` E-Mail: Phone No. �q'
I I
Fill in fee simple Title Holder on next age(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or morel a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTIO LIEN LAIN INFORMATION:
DESIGNER/ENGINEER: _NApplicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: !Nf t Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Ap lication is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has com enced prior to the issuance of a permit.
St. Lucie County makes no representation thi t is grantingia permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Dwners Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home O ers Association and review your deed for any restrictions which may apply.
in consideration of the granting of this reque ted permit,J do hereby agree that 1 will,in all respects, perform the work
in accordance with the approved plans,the orida Building Codes and St.Lucie County Amendments.
The following building permit applications al exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fence ,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure t( Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Nc itice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intE id to obtain financing,consult with lender or an attorney before
commencin •work orlp.,E Ing your gotice of Commencement.
Signature f see/Contractor as gent for Owner Signature o tractor Li a Holder
STATE O RID STATE OF F RIDA
COUNTYO - v� COUNTY OF Ste- • Ly.� \��
The forgoing instrument was acknowledgi d before me The forgoing instrument was acknowledged before me
this��o day of Ft 20 Es by this a, day of 201$by
` Name of person making stateme it Name of person making statement
I Personally Known OR Produced clentification Personally Known OR Produced Identification
Type f Identification Type of Identification
Prod c Produced
ignature of Notary Public-State of Ft
(Signature of Notary Public-Sate of Flori a)
Commission N oti�r Ariana VenetiAriana Venezian(Seal)
eziCommission No. JySTATE OF FLNOTARY PUBLIC
a •S7ATE OF FLORIDA
07 G-110 5 9 14
1e Exiair s 2J1412 222 fl
REVIEWS FRONT ZON1 SUPERVISOR PLANS VEGET �l N E � l J X22 MANGROVE
COUNTER REVIE1 REVIEW REVIEW REVIEW REVIEW REVIEW
HATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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