HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f
Date: :?Z12 Z7[f Permit Number-EAS 0 IQ T
1u RECEIVED
` MAR 2 2 2018
Building Permit Applicat on
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Planningand Development Services __ _ Y, per
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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:
PROPOSED IN ,ROV,EMENT LOCATION .:.
_
Address:
Legal Description: L,2P � /, t Uri EL SS 1-Z� � � �C/ �d[' t(�G5 l`(
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILEQ DES'.CRIPTION OF WORK
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CqNSTRIICTION INFORMATION... ° t
Additionalworkto e e performed permit-check P un er.t is.
p... . a that apply:
_Mechanical _Gas Tank: _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: S' Sq. Ft. of First Floor: .
Cost of Construction:$�, �GU =� Utilities: —Sewer _Septic Building Height:
O"', ER/LESSEE: CONTRACTOR:,"
Name a Name: c n
Address: �lCf <<9 �1r �v.�e . Company: P c a/1
City: ' I'oT� ►'� f cC State: r--• Address: CMC,
Zip Code: `3 K� �( � Fax: City: 1-p
State:.
Phone No.2 Z 7 60� W4 Zip Code: �� Fax: ??2� l`Y77�
E-Mail: Phone No
Fill in fee simple Title Holder on next page if different E-Mail n c 5C- �
from the Owner listed above) State or County License
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
St1^PPLENlENl'AL CQNSI"RUCTI0N LIEN LAVA IN QRMATIC N
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.
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Signature of w er/Lesse ntractor as Agent for Owner Signature of C ra r/License Hol4r
STATE O FLORIDA STATE OFF RIDA
COUNTY OF CIF. COUNTY O
The r ping instrument wa acknowledge before me The forgoing instrument was cknowledge before me
this day of 20 by thiso�day of 204 by
L�kr � 21jD.1P �1 `
(Name of person acknowledging) (Name of person acknowledging)
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(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificati Type of Identificati
Produced - ,:- Produced
"aYoJs KAREN S. N�
4 Com�g .0PCommission No. _ ' Commission No. ='�* K(�i�� 5
,' 1 o My Commissio„ r,F.;,,s - Comrh;s AliQ
° ;; June 1 ` 201 E -F .°a� INY C sion rF J N
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Un j 2 n FXPire,
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R VIEWS FRONT ZONING
SUPERVISOR PLANS VEGETATION SEA TUR �. VE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REV
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014