HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 4 �
`' , ¢ _.� .■,I� RECEIVED
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Building Permit Application JUN 0 7 2018
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division 9
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED IMPROVEMENT LOCATION:
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Address:
Legal Description:
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
41 _ S a Q
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: $ `�� C Utilities: _Sewer _Septic Building Height:
OWNERAESSEE: CO
Name ' ' 1 Name: ✓ t.(
Address: i "P_ Company: e 4.. rti '
City:— D! -Qyc e7 State: Address:�SI 2,5 •Z fY IL-0 Odtu i-c-c"
Zip Code: Fax: City: State:—;E4'
Phone No. = Z` 71- !:b1 1 V Zip Code: � Fax:
E-Mail: Phone No Z— LP 0 9—zo
Fill in fee simple Title Holder on next page ( if different E-Mail ('227 C.cs g2�2 9 tt 023 — G'
from the Owner listed above) State or County License !�4
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
UR LEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/EN (NEER: Not Applicable MORTGAGE/COMPANY: _Not Applicable
Name: &M Name:/Y/14-
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.
F"'f' r"" &'G 2rAqA�_� '/.a
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instru ent was acknowledged before me
thisi�day of ,�,f 120 1 y by this_UL day of 20i�4 by
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(Name of person acknowledgin ) 111111/ (Name of person acknowledging)
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( nature of Notary Public-State of FldZlcf)= _ kms (SiAature of Notary Public-State of FIa�21
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Personally Known OR Produce lderttifi"c�p�_ P<Znally Known OR Produc® Ideiti ll 1
Type of Identification �.W• ��eof Identification
No.QQ
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Commission No. \ (SeAl,;TE QF `, 2ommission No. + ( OF f%% �
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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