HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE 1 FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � Permit Number:
: II
RECEIVED
Building Permit Application AUG ?.01�
Planning and Development Services
Building and Code Regulation Division PermiW119
5T. Lucie County;
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential _
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSEDJMPROVEMENT.LOCATION
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Address: t—_—(Fr X71 r C�(JI �`F 1 v r o�c (tet_ ��`P''
Legal Description: &-c7_ 7/L.►C
Property Tax ID#: �1" 1 Q01 a a�� l Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED-DESCRIPTION.OF WORK:
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit-check a appy:
HVAC 13 Gas Tank []Gas Piping Q_Shutters Windows/Doors
`�Electric 0 Plumbing Sprinklers E]Generator O Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ �� fy� Utilities:OSewer Septic Building Height:
OWNER/LESSEE: J CONTRACTOR:
Name h?/Q'CName:
Address: 2 LI—I-rR Company: h,� --C-A-c7zr`L C.
City: State: F-L Address: '_?0-9'3S�� ,�I/YJP' "16 2— 2
Zip Code: Fax: City: 4 bi S /UO 6;;_ State-
Phone No. W3 -�> el Zip Code: 3y C_ Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: f Y15 C CLU ky'
from the Owner listed above) State or County License: C-_0 Q&3'�
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 thepermit 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,l 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.
Signature of O er/ ractor as Agent for Owner Signature of Con or er
STATE OF FLORIDA STATE OF FLORIDA �.�
COUNTY OF S"C I IJ C.e`• COUNTY OF /
The forgoing instrume t was ack owledged�efore me The going instru n was ackrybwledged-fore me
this day of (i'' 20 by this ay of �/ s� 20 by
'Ira;
�r 1a
N me of pe aking statement Nam f person aking statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatio Type of Identification
Produced Produced rN
JQRF FRPM11
(Signature of Nota: state of FIorJ9bq FRESNILLO (Signature of Notary Plyl' ' �df FJrztidp public-State of Florida
tee` lotary Public-State of Florida '1=° t - ' = Commission#FF 184850
Commission No, 4 TUU ComnkFA#FF 184850 Commission No. - My Co(+feadbires Dec 22,2018
P' � 8ondedthrou
My Comm.Expires Dec 22 2018 through National Notary Assn.r
at F1 Bonded through National Notary' Assn.:
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17