HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ] Fd Y" ��
Date: [)` Permit Number / ----- -�—�
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AUG 0 8 2018
Building Permit Application
Planning and'Developme,ntServices PeFI1iCIC3ger3f�s'tlTlellt
Building and Code Regulation Division St. Lu d e Co u n Ly, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
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PERMIT APPLICATION FOR:
PROPOSED INPROUEMENT LO ATION e yrs t� 5
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Address: Qbt� Liu zC ��� T/�/C�t�'G— /"—z
Legal Description:
Property Tax ID#: j`-/ rpm +�2 �t `� U� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK fir4 v=� '
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CONSTRUCTION INFORMATION � ` j
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Additional work to e pertormed under this permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric l'um bing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ v Utilities: _Sewer _Septic Building Height:
OWNER LESSEE = CONTRACTOR w a4 MIM
Name .Sl �Qfi��.�G" Name !� uoW f'
Address: / ! ��.f y 7-1-11Z Company:
City: Cif State:& Address:
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Zip Code: 334410
3 0 0/ Fax: City: State:�
Phone No.<s f l ���b - ���� Zip Code: Fax:
E-Mail: Phone No
Fill in 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.
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U �PL 'NIITAL�CON�7RUCTION 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 r
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,
access or to s,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WAR ING TO OW :Your failure to Record a Notice of Comm ncement niay.result in your paying twice for
impro ements to your roperty. A Notice of Commencement ust be recorded and posted on the jobsite
before first inspecti fit. If you intend to obtain financing, co ft with lenderan attorney before
com n ' work or recordin our Notice of Commencem
Signature of Owner/Less /Contractor as Agent for Owner Signature of Contrac r/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20_ by this day of 20_ by
(Name of person acknowledging) (Name of rson acknowledging)
M
/XA AA
(Si ature of tary Public-Stat of Florida) (Signature of Notary Public-S ate of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
.Type of Iden l a l Type of Iden l ,
Produced Notary Public State of Florida Produced Notary Public State of FIOrida
OuPhia Harris
My Foo;,,salon GG 238873 My Commiwion GG 23q¢7s )
Commission o orw Expires osl3a2o2o (Seal) Commission o C*$V Expires osl: ,2e2o teal
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014