HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ` u
Date: - a $ Permit Number:
J -s. I cmo FRECEIVED
• MAR 1 2 2018
Building Permit Appliqation
Planning and Development Services ST. Lucie County, Permitting
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: Q _ `
PROPOSED INPROVEMENT LOCATION:
Address: ,37 PEt\iC)UL , LW, f-
Legal Description: (tt� �iR�3�[Za! iL� �,d,�/-�rVNA C ��.� I3 ts��tL S l �a/�T Z
Property Tax ID #: 3 LtZS__ `)n( 1-2Z4O 6r)Q— G;-' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _ Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Z[n.0 Sq. Ft. of First Floor:
Cost of Construction: $ ���' Utilities: _Sewer _Septic Building Height: ra
OWNER/LESSEE: CONTRACTOR:
Name ,�ln;,v c l l is t:lb► i Name:
Address:3732- PEI Ibu\4x C' AVZ, _ Company:
City: r S L State: j, Address:
Zip Code: 3 4q ? Fax: City: f c Stater,
Phone No. 211 1 _]1(4 Zip Code:-5Ltic%uZ Fax: 4(a1A2LtS-_-
E-Mail: Phone No '7`77 02- l4- —O
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 property. A Notice of Commencement must be record and posted on the jobsite
before the first ' pe ti f you intend to obtain financing, consult wit nder o an attorney before
commenci ork recor 'n our Notice of Commencement.
Signature of Owner Lessee/Contractor as Agent for Owner SignatureContrac ' ense Holder
STATE OF FLORIDA STATE OF FLORA
COUNTY OF 6A, L�� 2 COUNTY OF . l.pc
The forgoing instrument was acknowledF d before me The forgoing instrument was acknowledged before me
this\� day of �a� 20\ by this day of TN%r 20A_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P lic-State of Florida ) (Signature of NotaYy Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced 'rC t' L^ Produced r-vvrNs
y�GNENSO�3 � J"'• Oct Al V #GG 022023
Commission No. �` �g�N#GG0�20 Commiss �kl rts,2o
COMA mbet 16, leB ,�' c public Unde
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REVIEWS FR Y""""'" G SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COU REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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