HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR,APPLICATION TO BE ACCEPTED
Date: _ '�' Permit Number: I
RECEIVED
s _ Building Permit Application
Planning and Development Services = Y.L o ij'2018
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ST, Lucie county, Permitting; _
Phone:-(772)462-1553 Fax:-(772)462-1578-- Commercial- Residential-
PERMIT- PPLICATION
esidential-
PERMITAPPLICATION FOR: To_Select from dropbox, click•arrow at the end.of line
Al
C—ty
PR'O,POSEDIMiPRs1ti/E11%I`ENTLOCATION
Address �• C'7. r^LQ I DE
Legal Description:
Property Tax ID#: , lb La 0 I ,0 oc)o I Lot No.,
Site Plan Name: - Block No.
Project,Name:
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Setbacks Front'' Back: �� ;" Right Side: i�2 Left side: Z�-Z ��
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i lona wor o e e orme un er is perms —c ec a appy: '
HVAC- - -- - �•GasTank--- _ -•,-�GasQiping _Shutters- -- •-,-Windows/Doors- •
'Electric 0 Plumbs^ng : Sprinkles` Generator Roof , Rdof pitch
Total Sq. Ft of Construction: ••- Sq. Ft.of First Floor:
Cost of Construction:$-oil a�0•n Q Utilities:Sewer Septic Building Height:
•
�OWN'ER/LESSEES
Name Ll rc1 -nnrl Tnrmo nr �-I'l Name.
Address: 61 1 I 01(1P fir(()c 'Company:
City: F f __p.fe((;0 _ State: L-__ Address:
Zip.Code: °M qh ` ;Fax: City:, State:
Phone'No:'91 a 3�'0 C9 t Zip Code: Fax:
,E-Mail:, 1410r- 'Yl0 (orrin.1-corn Phone No.
Fill-int fee simple Title Holder on next-page(if different E-Mail: _
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.
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)I rc ��m
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF k . COUNTY OF
The f rgoing instru e t was acknowledge before me The forgoing instrument was acknowledged before me
this day of 20J by this day of 20_ 6y,
Name of person making statement / Name-of person making statement
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification .
Type of Ide tion Type of Identifcation '
Produced r L. Produced
(Sign ture of Notary Pu cI (Signature of Notary Public-State of Florida)
KAREN S. NIELSEN
�`���° °�'=State. S�ai ida-Notary Public
Commission No. -z �: � . ) Commission No.- (Seal)
Commission # GG 207464
+,� oP� My Commission Expires
°nii ` Z.
Juna 12, 2022
REVIEWS FRONT ZONING - . _SUPERVISOR- PLANS VEGETATION SEATURTLE 'MANGROVE
COUNTER REVIEW REVIEW. REVIEW_ REVIEW REVIEW REVIEW .
DATE
RECEIVED
71
DATE
COMPLETED
Rev.8/2/17