HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFCO/MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �' y ' b Permit Number:
Jf � » RECEIVED
JUL' 12098
Building Permit Applicatio
ST. Lucie co nty, PerJt -
Planning
and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: � ` 1•k WCAW lb®r
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�PRP�a�EDlNRDUEM NTLaCATI q�}r" r�Fw
Address:
Le al Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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4� ( a,+ut ,#.`"i,..r�' i. 3Ts .m .,euOWN
Additional work to a per orme underthis permit–c check a that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Constructn:_ Sq. Ft. of First Floor:
Cost of Construction:$ Mtilities: —Sewer _Septic Building Height:
NameName:
Address 0 Company-.-
City:
ompany:City: State: Address:
Zip Cod Fax: City: State:
Phone No. ()`—, c ' Zip Code: Fax:
E-Mail:,�[' one No
Fill in fees mple Title Holder on next page( i 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.
• S. =1'�L� EN A�. �C+}N�`�Tl�r �1'I'CIN �� LAUt/ �vOR A1"1'aN..
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 w rk or recording our Notice of Commencement.
Signat4ofn r essee Contractor as Age or Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ,�, LUC,I.c, COUNTY OF
The forgoing instruent was acknowledge before me The forgoing instrument was acknowledged before me
this day of 20 by this day of 20_ by
Name of per on making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type,of Ident' ' do Type of Identification
Produced (_ >' Produced
(Sign ture of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida)
``gar P���
Commission No. �P KAR( al�, NIE�EN4iCommission No. (Seal)
o_ tate of Florida-NotaCommission-# GG
i��`` n xpires
June 1 , '
REVIEWS FR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 8/2/17