HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: EA 1 , 1 Permit Number:
J
RECEIVED
• MAY 02 2018
Building Permit Applicai,on=
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Planning and Development Services -
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 INPROVEM
Address: (�U L- �ii-:PA A [lS ISwOt
Legal Description:
Property Tax ID#: �°�� 515- Cita�3 d4A 1 Lot No._/�
Site Plan Name: , c�. cam,I Block No. 1
Project Name: Q M LJ
Setbacks Front Back: Right Side: Left Side:
Or\ � ` too
NM
Additional work to be pertormed under this permit–check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _ Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ >CO Utilities: _Sewer _Septic Building Height:
Name �l 3Q L C Name: F�G�n
Addressf: �(X)� �f; ti l,•5 Company:hllyk Ad On4yZ6i7U'®•
City:}L State:I Address: �tt�lu-
Zip Code: Ski (�� Fax: City::��7 I&Jc Statel—L
Phone No. Zip Code: 7q�,Q Fax:
E-Mail: Phone No 1 :�2 1 - f f! - 7 S�
Fill in fee simple Title Holder on next page ( if different E-Mail � L 1 Sc cilN10..
from the Owner listed above) State or County License 3d
dA
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
UPPLEMENTAL 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
improveme o your property. A Notice of Commencement must be recorded and posted on the jobsite
before the irs inspe n. If you intend to obtain financing, consult wit ender or an attorney before
commericin ork g4recording your Notice of Commencement. 14,
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Sign ture ofWrier/LealCractor a/Age or Owner Signature o ntractor/Licens old
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF L COUNTY OF
The forgoing instrument was acknowledge_1 before me The forgoing instrument was acknowledged before me
this.a day of ('^ 20_AX by this_a,day of Vey 20)J by
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(Name of person acknowledging) (Name of person acknowledging)
(Signature of Nota ublic-State of Florida ) (Signature of Nota Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification __e�rrr Type of Identification
Produced --g:GVEV6 Produced . — {��AMARIEGtVENAS 3;
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_ 0 1S510N#GG 02 02U 12 MY COMMISSION#GG i...z
Commission �Mtd ecem d�es�� Commission No.t—G PIR @ 'bett6'20�fiW
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REVIEWS ONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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