HomeMy WebLinkAboutbuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -3-1 Z - `18 Permit Number:
RECEMED
•
Building Permit Application MAR 12 2018
Planning and Development Services perrnittinq Departmew
Building and Code Regulation Division 5t. Lucie Count
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential _,X_
PERMIT APPLICATION FOR:
PROPOSED INPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID #: MOL - Wl0 - Q3 I - U) 0 - Lot No._
Site Plan Name: Block No.
Proiect Name:
Setbacks Front Back: Right Side: Left Side:
Mechanical
Electric
_ Gas Tank
Plumbing
_ Gas Piping
Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Shutters
_ Generator
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Windows/Doors
Roof Pitch
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Company:
Address: �'�
City:, �►�xCQ� Stater
Address:
City: State:
Zip Code: Fax:
Phone No. '1'L�- ��`J�i" z5oo
Zip Code: Fax:
E -Mail: I,A; �?.O�-�^1p�CT�lc�
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 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
commencir rk or recording your Notice of Commencement.
ee/Contractor as Agent for Owner
STATE OF FLORID
COUNTY OF�2t Ls�4 ; e
The forgoing instrument was acknowledged before me
this Idayof 1rY\t1Sa:iAA ,20-LYby
S' - , 0U r
(Name of person acknowledging )
IBL' c m,2_
(Signature of Notary PubliK-,gtate of Florida )
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of , 20_ by
(Name of person acknowledging )
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification Personally Known _
Type of Identification 11 Type of Identification
Produced V��— Produced
Commission No.fission No. _
YP'' ATHER BUR FO D
_state of Florida -Notary ublic
REVIEWS FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014
My Commission p res
Rb�A$ P NS VEGETATION
EW REVIEW
OR Produced Identification
(Seal)
SEA TURTLE I MANGROVE
REVIEW REVIEW