HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �' Permit Number:
.�' on RLCELOVE'D
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_ Building Permit Application , JUN 2 8 2018
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lu Oi County, FL
Phone: (772)452-1553. Fax: (772)452-1578 Commercial ReSI `
PERMIT APPLICATION FOR:
I.P4 IN ROVEMENT LOCATION:
Address: e–'
Legal Description:
Property Tax ID"#: �L( 1� �d ( ( pS S`^– CDdU r Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF %7RK1111111il III
w In AL �
CONSTRUCT O INFORMATION:
itiona .wor to a per orme under this permit–check a that appy:
/Mechanical _Gas Tank Gas Piping' .` _Shutters _Windows/Doors
C_Electric _Plumbing —Sprinklers _Generator _Roof Pitch
` dJ
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction0 Utilities: —Sewer —Septic Building Height:
OWNER/LE-�SSEE: CONTRACT®R:
Name r Name: ,DI eq.
Add r s: �l l�c,ti Company:nv-c Com " ✓� C
City:l"-[ ( S (–v,, , Stater Address:Fc,0 vd 617r �_�
Zip Code: �C('S–A Fax: City:l�d� -S C�� State:TC
Phone No. 77,) r C1079 Zip Code: J!t 9 Fax:
E-Mail: Phone No 7 J 7� ,--
Fill in fee simple Title Holder on next page(if different E-Mail Care C 1-:1/((f.Q0/i'�
from the Owner listed above) State or County License CSC KSI2�IaS
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
StJPPLEi IENi"A►L CC®?'NSTORiIJCTION LF aN TUU I,NF®R11/iP►TIO"N
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
I mprovements 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 recor*g your Notice of Commencement.
N W rRj o
S re of Owner/Lessee/Contractor as Agent for 0 r% = ignature of Contractor/License Holde =fie a
xamO r
STATE OF FLORIDA �� r m
mom._ TATE OF FLORID syw
COUNTY OF �i OUNTY OF
The f g ins t was acknowledg fore me iw o he fo}�aing,inst me t was acknowledgecfl�efore e
this day o 20" by his day o 20Z by ;�P'001
(Name of person acknowledging Name of person acknowledging)
(Signature o otary Public-State of Florida) (Signature of Nota ublic-State of Florida ,
Personally Known OR Produced Identification Personally Known OR Produced Identificatio
Typeof Id ' 'cType of Identification
Produced atio ,. . ` t Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014
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