HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: - 3
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Building Permit Application RECEIVED
Planning and Development Services JUN 0 2018
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Re ST i ou ermitting
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION.
Address: ae M ejkL5 P-JV
d, 22'L'I 5ol 6-eam
Legal Description: - Gf1
d ivl /'�yh�i✓ll1Y� ��IL�i�t Qy�
Property Tax ID#: °���� -,`=�J�- C���o2 -GG6 Lot No.
Site Plan Name: Block No.
Project Name: 1Cx
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
1f1'5kLJ `2if*
CONSTRUCTION INFORMATION:
Additional work toe nertormed under this permit-cleck all appy:
HVAC 0 Gas Tank Gas PipingMGenerator
Shutters Windows/Doors
11Electric0 Plumbing OSprinklers Roof ® Roof pitch
Total Sq. Ft of Construction: e/qG S . Ft.of First Floor:
Cost of Construction:$ _7�23C Utilities: Sewer Septic Building Height:c�o� r
OW N ERAESSEE CONTRACTOR:
Name ( 0 t)OC C) Name: Cc.
Address: (0&0 Company:
City: StateVU Address:
Zip Code: �� Fax: City: V State: t'1__
Phone No.go—'�i3�",[��� Zip Code: 3qqcr7 Fax: TZ;2 --'S7 -7-7
E-Mail: Phone No. X702 07
Fill in fee simple Title Holder on next page(if different E-Mail: L2.c:tu&c CocLa a .C`vvc
from the Owner listed above) State or County cense:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFO:RMATION:,
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
com n 'n or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor icense older
STATE OF FLOR76J`�
STATE OF FLORIDA
COUNTY OF O COUNTY OF
The for oing instrument was cknowledged before me The forgoing instru gent was acknowledged before me
thi day of 20 by this day of 201TSby
Name of person making statement N e of person making statement
Personally Known OR Produced Identification Personally Known 'X'—OR Produced Identification
Type of Identi is t' Type of Identification
Produced (._� Produced
(Signet re of Notary Public-Sta a orida) (Signatu)a of Notary Public-St f rforicla)
Commission No. (Seal) Commission No. REBECtSAhSTIFO
MY COMMISSION#GG91863
v P ��®aP` EXPIRES:May 17,2021
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MY CO MISSION#GG9186
REVIEWS PFS TEXP 9Hll�2021 UPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
B 01
REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17