HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c3
Date: L /(p Permit Number: 1�d5J �3 1
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Building Permit Applic�tiorVAY 14 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: S
PROP n . :
Address:
Legal Description:
Property Tax ID#: 33a� oda— CS d11 fid'" Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF
Additional work to be pertormed under this permit–check all tatap y:
_Mechanical _Gas Tank _Gas Piping Xhutters _Windows/Doors
Electric _ Plumbing _Sprinklers _Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $O � - y Utilities: —Sewer _Septic Building Height:
ER LESSE CONT OR:
Name S'Oti\ Name:��
Address: S�cS��\� '��o`` t^ Company:
City: S L State: Address:
Zip Code: 3`{ Fax: City: aS �O State:A_:�—
Phone No. 515'- a$93 Zip Code: 3 C Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License a`X03
LIf value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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
commprfqng work or recording our Notice of Commencement.
rTA1T
ure of Owner/Lessee r as Agent for Owner Signature ontractor/LicenseHolE OF FLORID ST OF FLORIDA
COUNTY OF COUNTY OF -S-Ir, L-u
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledge before me
this day of� 20) by this_\LV day of may 20_IX by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary PuRic-State of Florida ) (Signature of Notary Pu lic-State of Florida )
Personally Known OR Produced Identification Personally Known _ �enti a t i o n
Type of Identification Type of I 'NN "�It ozzoz3
SSiON#GG6
Produced �1. L Produced :�.�:• :" oM,al.
�21eG�NS = ' `*= r.XP1R � derwnle�,
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REVIEWS FRONT t_...0 G SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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