HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �3 l$ Permit Number: 2,
RECEIVED
Building Permit Application
Planning and Development Services MAY 2 3 2018
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 ST. Lucie County ermitting
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: lef _- 'e, -
Legal Description:
Property Tax ID#: Y0/-006_ -03,0 Lot No. 9
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work toe performed under this permit-c ec aMa,ly:
HVAC 0 Gas Tank ❑Gas Piping _Shutters a Windows/Doors
Electric ❑ Plumbing 0 Sprinklers ❑Generator ❑�Roof Roof pitch
Total Sq. Ft of Construction; S ]Ft of First Floor:
Cost of Construction: $ '��30D UtilitiesSewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name:
Address: Company:
City: State:25( Address:d /moo
-
Zip Code: 34f-a-- Fax: City: 7"/Jti lk;6& Stater
Phone No. '7-7Z f-00.3.5— Zip Code: J��Zfk Fax: 77-4-
E-Mail: /n62q 7- '7[G? 6Q . Cdr- Phone No. 72Z
Fill in fee simple Title Holder on next page( if different E-Mail �t r� SOfoS�'�G. 647-? i
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 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
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.
ignature of Own r/LessVe/Contractor as Agent for Owner Sig ture o ractor/License Holder
STATE OF FLORIDA STATE( F FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this /S- day of � 20[x' by this/,-day of_ 20/f by
2221-A20cl c,/ /7). k C_L L
Name of p rson m ing statement Name of person,Making statement
Personally Known OR Produced Identification Personally Known 1OR Produced Identification
Type of Identification Type of Identification
Produced — Produced
(Sign 'of Nota P/Publial State of Florida (Sign of Notaryubli_ol State
IRA L.LATOS MOIRA L LATOS
Commission No. ,r_ Py" #FF 14443 S I
�'�• �t= P,10�41�tISSION#FF 144434 Commissi :'�Y•• ��- �AaISSION `� )
EXPIRES:August 12,2018 EXPIRES:August 12,2018
''• �• y;' P.cnded Thru NWary Public Underwriters J %,±r:....�r�' 3;nded T'nru Notary PUO Under stem J
f,'
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17