HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -
Date: Permit Nu er: _ J
• RECEIVED
Building Permit ApplicatiLPermitting
APRC 17 2018
Planning and Development Services 2Building and Code Regulation Division epartment2300 Virginia Avenue,Fort Pierce FL 34982 Lucie U ntyr FLPhone: (772)462-1553 Fax: (772)462-1578 Commercial
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: u 0 �� „11fsr+h W�-I 3iq qq(� L-6+ 4::k b
Legal Description: (_(sc (\,+TU Imr)Q r �OYY�e 1
Property Tax ID#: ?" � �� C) o-/ - 000-D Lot No.
Site Plan Name:('rsl AA W4 COUe— Via ,le hDYriP, Pu Block No.
Project Name: c
Setbacks FrontBack: Right Side: Left Side:�J
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION 1NFORMATION:
Additional work toe e orme under this permit-check a appy:
❑HVAC Ei Gas Tank []Gas Piping _Shutters ❑Windows/Doors
❑Electric ❑Plumbing ❑Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction:. S . Ft.of First Floor: L R�
Cost of Construction:$ Utilities: Sewer[]Septic Building Height:
OWNERAESSEE: < nn CONTRACTOR: ;5 carat\ C t
Name CDS b. e e Name: SILY1i lk-e- . IA
Address: - Company: S �uJ1�e� ISL
City: State:'L Address: 58 L'
Zip Code: 3 Fax: City: Stater
Phone No. 2- Z�S'L- qq Zip Code: Fax:
E-Mail: Phone No. -9
Fill in fee simple Title Holder on next page(if different E-Mail: 11 Ln 4,1, 1S Q_x0 -0 . co/Yl
from the Owner listed above) State or County Licenser /10,S-610_D
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. L? (o3 U
t
SU"PPLEMENTAL 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 thepermit 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 Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF P 6�K COUNTY OF���
The fo oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of h'tCut G� ,2018 by this day of �l�l(C,h 20J3 by
'SSYz1 n .m��A 1.� �17I>1 mcco l
Name of person making statement Name of person making statement
Personally Known�< OR Produced Identification Personally Known X OR Produced Identification
Type of Identification Type of Identification
ProducedO W
�� rltc r) Produced��
(Signature of Notary Pub' State of Flo ' a) (Si nature of Notary Pub c- ate of FloMa
a)
Commission No. Seal Commiss'
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REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17