HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: CO(S
^ RECEIVED
Building Permit Application FE3 2 7 2018
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: C1,71 T6�fiCr'1
Legal Description: G P t � kr) Z'7
Property Tax ID#: 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 toe performed under this permit—check a apply:
HVAC0 Gas Tank []Gas Piping Shutters ❑Windows/Doors
Electric ❑ E]
Plumbing Sprinklers Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction: $ ::210 0 Utilities: Sewer E]Septic Building Height:
OWNER/LESSEE: ONTRACTOR}:
Name Name:
Address: 6171 E;Q�Lc,^ ng t 5 (fig-, Company:
a
City: Qi e,t C_ State:jr4 Address: 36!�i (Z 'kA:
Zip Code:-31ct`(�3 Fax: n/1F City: State:
Phone No. 77L — 32 1 — )`➢—rG Zip Code: 3ycitj Fax: /y/4
E-Mail:yK.�930 C'_M 6 t Phone No. 77Z— )7- 1.77
Fill in fee simple Title Holder on next page(if different E-Mail r,S t(i— � n�wi
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
commencing work or recording our Notice of Commencement.
ture of Owner/Lessee/Contractor as Agent for Owner ign re of Contractor/License Holder
STATE OF FLO IDASTATE OF FLORIDA
COUNTY OF-1 pidQh fj! .kr COUNTY OF IrA n yely -
The fRRr oing instr nt was acknowledged efore me The for oing instrumentwas acknowledged efore me
this L�day of 20��by this day of 20� by
Name of pers making statement Name of perso aking statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification f Type of Ide t'fiation
Pro uced r ` Produced
igna a of Notaryblic-State of Florida ) ign a of Notary Public-State of Florida )
Comm] 'Is :ASHLEE K1Maon��..H Commission j. `�,. ASHLEE KIMB13O GH Sea
•• : ; �0
E COmmission#GG 0 =Commission#GG 023566
Expires Aug 220 Expires 23,2020
?k Ex it August 23,2020 `'3 e August
•yoi i.Q. �..
�. 1019
REVIEWS FRONT SUPERVISOR PLANS VEGETATION SEA TURTLE NGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17