HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
RECEIVED
Building Permit Application APR 0 6 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting)
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
Address: –>t
Legal Description:
Property Tax ID#: h��� — ��1 1 ,.�. i
' ��' �, _ � �'t —,''"�"7''� h Lot No. � h
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
AUUMUnal WorK to be performed uncler t is permit–check a t at appy:
_HVAC _Gas Tank _Gas Piping /Shutters _Windows/Doors
_V/Electric _Plumbing _Sprinklers _Generator _Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ `l Utilities: _Sewer _Septic Building Height:
FINdute
WNER/LESSEE: CONTRACTOR:
�1hL� un e:__ f-t b•= tie.: 1� h SL:�
Address: �E�(")-f Company: L
City: Z State:. Address:
Zip Code: Fax: City: '� p
State:_ C
Phone No. C Zip Code: Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page( if different E-Mail: m' t-'( ,` y ,
CCt 7
from the Owner listed above) State or County License: �,1
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: Yourftilure to Record a Notice of Commencement may result' your paying twice for
improvements to your property. A Notice of Commencement must be recorded d posted on the jobsite
before the first inspectio if you intend to obtain financing, consult with lender r an attorn before
commencip
s.work orlrecOrchng your Notico of Commencement.
Signature of Owner se oiit cl3 as Agent for Owner Signature of Contractor/� ns Ider
STATE OF FLORIDAT
STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instr ent was acknowledge efore me The forgoing instrunkm was cknowledge before me
this day of I 20_" by this AL day of 20 by
t�SC6 1� \Ifj A'sCA
Name of per7 making statement Name of per n making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of I entification Type of Identification
Produced Produced
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. ""' KANIELSEN Commission No. __,_
ate: c Commission# FF 115637
sy�,2 KA � S. NEE
_ *? Commission A FF
a+ „ My Commission Expires _ _ 115637 i
1 201 8 My Commission Expires
—— '"" 2 01 8
r __
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17