HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -0-0a7
Date: 4 lyh g Permit Number
Building Permit Application JUN 0 4 2018
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lycie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Rest en
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
-PROPOS ED-I M PROVE M:E,NT LOCATION: w.,
Address:
OCATION:---
Address: Saoq 614�" &_% "� ,
Legal Description: &A&o --- M- 07
Property Tax ID#: Bjmw- 4 08- 0-,//,? - 000. 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:_Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
NSTRUCTION INFORMATION:
CO
Additional work--to be nerformedunder this—permit-check-a-[[ apply:
HVAC Gas Tank Flas Piping In Shutters Q Windows/Doors
Lo Electric 0 Plumbing E]Sprinklers F]Generator F] Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ If 6,06)._06 Utilities:0Sewer Q Septic Building Height:
OWNERAESSE-E: .-CONTRACTOR:
Name 772am od Name:
Address:,/,? Company:
City: State:,---.J-4 Address: Stat;:
Zip Code:.3#95.
I Fax: City:
Phone No. Zip Code: JV9,0<6' Fax: 11-41--2#77S'
E-Mail: Phone N o. -44(0--zt=a____7__9__9_
Fill in fee simple Title Holder on next page(if different E-Mail: /b;
from the Owner listed above) State or County License: '0�50_
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
I�
SUPPLEMENTAL CON-STRU,CTION`LI.EN LAW:INFQRMATION
DESIGNER/ENGINEER: �Not Applicable MORTGAGE COMPANY: "ot Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: 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 its 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 intend to obtain financing, consult with lender attorney before
commenci work or recor ' our Notice of Commencement.
Sigrifftilrd of Owner ess /Contractor as Agent for Owner Sig a re of coiractorVficense Holder
STATE OF FLORIDA_ STATE OF FLORID ���
COUNTY OF �...Ll'.Cd COUNTY OF
The for ping instrument was acknowledged before me The for ping instru nt was acknowledge efore me
this day of 'V 20� by this day of v�'_�.._,20��by
Name of person aking statement Name of persop making statement
Personally Known�OR Produced Identification Personally Known t/ OR Produced Identification
Type of Identification Type of Identification
Pr ed Produced
(Signature of NotaryPublic-State of Florida} C7 DA69ure of Notary Public-State of Florida
DAVID RAYMO }
r DAVID RA PRUE
Commission No. 1aa�1a X NOTARY PUOF FB ICLC t mission No. �Q 2Ca`1� tlExpires
NOTARY PUB i
s' Ccxnm#FFi9 75 STATE OF FL DA
Comm#FF19
1126 2 9
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17