HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: S__ � ' (9 Permit Number:
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Building Permit Application
Plonning and Development Services
Building acrd Code Regulative Division
2300 Virginia Avenue, Fart Pierce Ft 3498
Phone: 4772) 462#1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: 'To Select from dropbox, click arrow et the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: c -;2q1' 2I-Af- n--�
Legal Description: C����r_...�� � �'sS vn, �� — SC CIO
Property Tax ILS #: ca?' ! G c S Lot No_
Site Plan Name: Block No. _L__
Project Name:
Setbacks Front Back: Right Side. Left Side:
CONSTRUCTION INFORMATION*
Additional work to be OerTormeO under ti-i€s permit — cneex all 112al apply:
11FIAC F ] Gas Tank11
. Piping _ Shutters Windows/Doors
Electric Plumbing
OSprinklers � Generator 0 Roof l��sof pitch
Total Sq. Ft of Construction, 5^. Ft. of First Floor:
Cast of Construction: $ utilities, Sewer D Septic Building Height:
'-OWNE`Rf LESSEE: -
CONTRACTOR;Name_.
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Address: ) o S. J Q
Name:
Company: �^ "
Address: L, Q 551A (ar .
City: . P; State:
zip Code: Fax:
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Phone No. 2�_!a -x _-
City: < fit- State: E✓ Tl
Zip Code: _ 0( Fac:_ Zia ta
Phone No.
E-Itllail:
Fill in fee simple Title Holder an next page ( if different
the Owner listed above)
i
E-Mail:1'^ c C"from
State or County License: 6% � 7 -
If value of .onstruction is 52500 or more, a RECORDED Notice of mmencement is requireta.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address: -
Nage:
Address:
City: State:
; Zip: Phone:
City: State:
Zip: Phone
II FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
I BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
City:
Zits: Thane:
Zip: Phone:
Name of person making statement
Name of person making statement
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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, I do hereby agree that 1 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 your Notice of Commencement.
Rev. 8/2/17
Signet' o caner/ Lesse tltrr as Agent for w r
Contracto�icense Holder
R aTATE OF FLORIDA
I STATE OF FLORIDA �
COUNTY OF
COUNTY OF
i The fo in instrument was acknowledged before me
't.�
The forgoing instrument was acknowledged before me
this ryday of " I_ 2CJ by
this day of �- _o- _ 20/j by
L
e,,
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known " OR Produced identification
Type of Identification
I
Type of Identification I
Froduced
Produced
Signature of Notary Pula , ' s tori 94N M RAULEF3SON
igtlature of Notary Public 5tate of Florida �
• IVOfiry P DllC •
+ 1 Stats o! Florida
Commission No, �. -. 6 I�sion # FF 965546
Commission No. (Sea z2
°bgINA
°• °` •*'' MY Comm. Expires Feb 26. 2020
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REVIEWS
FRONT
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SUPERVISOR �
PLANS
VEGETATION
SEA TUR TILE
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COUNTER
REVIEW
REVIEW �
REVIEW
REVIEW
REVIEW
e DATE�;a
RECEIVED
DATE
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COMPLETED
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Rev. 8/2/17