HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
Date: Permit Number: 1 1
RECEIVED
Building Permit Application
Planning and Development Services MAR 0 9 2018
Building and Code Regulation Division ST. Lucie County, P rmittin
2300 Virginia Avenue, Fort Pierce FL 34982 g
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line \e� ri C�ft
PROPOSED IMPROVEMENT LOCATION:
Address: '�el7 C F,s t t-,u_a &�
Legal Description:
Property Tax ID#: _Iy 57- ( r)6 �� COT' fJ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�d 4 I�gF��a�Va e ,1•��1 0�l/ �d✓H orP� C o�/J(9 d� 20 /� �k
O rid, � IU NJre S lab c, P40 5 �,
CONSTRUCTION INFORMATION:
AdClitional work to be nertormed under this permit—check all t1i appy:
HVAC Gas Tank ❑Gas Piping MGenerator
Shutters Windows/Doors
Elf-lectric F Plumbing ❑Sprinklers Roof Roof pitch
Total Sq. Ft of Construction: 2 (V S . Ft. of First Floor:
Cost of Construction:$ 1660' Utilities:Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name /� �4' 2 Name:
Address: 1145 ( Company: i G
p Y� 7-R�
City: State: Address: 9 E 2 l 1�
Zip Code: Fax: City: (fes v'; 0-P„ r 11 State:f /
Phone No. `'-5:_L/-3 3S - .�Sz S Zip Code: Q C Fax:
E-Mail: Phone No. `7 k —p n i T9 -5-
Fill
Fill in fee simple Title Holder on next page(if different E-Mail: ��
from the Owner listed above) State or County Licenser (3 f, 6 v<,k
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
commencing work or recording our Notice of Commencement.
Signature O ee/ ontractor as Agent for Owner Signatu ofo r r/License Holder
STATE OF FLORA_ STATE OF FLORI
COUNTY OF ��I ( UC t COUNTY OF —. (
Theoing instrume �w� ac ki o ged before me The or oing inst u t inns agcno edged before me
this day of S AJ 20J2 by this day of 20JD by
I
Name 4f person making state e t Name of person making stat ent
Personally Known OR Produced dentification Personally Known OR Produced Identification
Type of Identifi tion Type of Identifi tior��
Produced �— Produced
(Sign ture f Notary Pu it- of Florida) (Sig to a of Notary Public-,State of Florida )
mmission N I , N0��t jyblic-State of Florida ';Commission No., U lq °a Seal)LgUR,
.' Ny Comm.Expires Apr 24,2058 •�, ( 4 MANN
PJ°tarY public_
- State o
Commission#FF 094692 y• cv My Comm.Expires Of Flori a
OF qP
.,'°•` Bonded Throuc h National F P r 8
s��; 77 ,. -. Bonded FF 094692
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA`I`l1RT`PEf- rc IQbgss 1.
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW RE
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17