HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5 �a.2, o Permit Number:
_ , A RECEIVED
Building Permit Application MAY 2 2 zOt8
Planning and Development Services ST. Lucie County, Permittinq
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: C� 7' -q3�` "& ')�)i_ 131-L J
Legal Description:
Property Tax ID#: 1� a�O 5�O- dd � ' dad - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Pe 1_ - 01N O U 7 I.AS PE`Z
CONSTRUCTION INFORMATION:
Additional work to be pertormed under this permit-check all that appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
�lectric E] Plumbing Sprinklers Fi Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $_ Utilities: []Sewer[ Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name I_EwI F Name: ATHc1P, eNGCLM,gNYI
Address: JSN roJ�_ LA VES DP_ Company:Ae'cy"g C-Lgc-Tkl it COr anClA,6, we
City: P p,K C i 1-,L/, State:0 r Address: 7173 G0111071 P1-
Zip Code: 87q0(' C Fax: City: P2T ST LUCIE State: FL
Phone No. 5��- r�o��' � Zip Code: � `�15a Fax:
E-Mail: Phone No. 77 370-S_75_5
Fill in fee simple Title Holder on next page(if different E-Mail: Acrus ie EUEC%R1C.P- iL (-90U-rW09, gaff
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUMON LIEN LAW INFORMATION:
DESIGN ER/ENGIN EER: 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,per-form 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 fir i spection.-If you intend to obtain financing, consult with lender or an attorney before
commencin rk or reg"ing your Notice of Commencement.
�ig_natuWof owner essee/Contractor as Agent for Owner SignAure of Con ctor/License Holder
STATE OF FLO A STATE OF ORID
0
COUNTY OF--; 1�� COUNTY
The forgoing instrupent was acknowledged before me The f oing inst ent was acknowledged before me
fof 039, '2
this da) 120��by this A/ day of
Name of perso,n makin(i'statement Name of person mKing statement
Personally Known 01 OR Produced Identification Personally Known,(?!S�011 Produced Identification
Type of Identification Type of Identification
Produced Produced
4111011,40011,11,
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0
(Signature of Notary Public- (Signature of Notary Public-State ck@ffW!JWjj
Commission No. (?eal). Commission No.
s* ,
OGG07'07 Z': OGG A37
SO;- 490
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REVIEWS FRONT ZONI00111�110110111 OR PLANS VEGETATION SEA TU E
COUNTER REVIEW IEW REVIEW REVIEW REVIE /it 114IR W
DATE
RECEIVED
COMPLETED
DATE
Rev.8/2/17