HomeMy WebLinkAboutBuilding Permit Application I
I -All APPLICAB-ALE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �1
- = I Date. / I Permit Number:
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Building Permit App icatio�
UG 6 2018
x _-,Planning and Development Services Permitting Department
Building and Code Regulation Division S�. LLICIe �G
.mss* --2300 Virginia Avenue,Fort Pierce FL 34982 ty, FL
- Phone: (777)462-1553 Fax: (772)462-1578 Commercial Resldentia
PERMIT APPLICATION FOR: u
I . 31
INPROUEIII ENT LOCATI(?N:
- Address:
- Legal Description:
..•.,Tr iD#: �- at �� � � . `—mow^ � Lot No.
._f ropcI ty ion
_. __$ite--Plan Name: Block No.
Project Name:
ISetbacks Front Back: Right Side: Left Side:
WANK SCRIPT ON , O K:
C)L
OD
• CTI&N I INFORMATION:
Additional work.to be pertormed under this permit-check all t at.app y
Adechanica'l _Gas Tank Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 3g50 Utilities: Sewer Septic Building Height:
• M SSE CONTRACTOR:
Namh-4 - Name: 3-0,S GuQ _
Address:-R, �% Company: C�ago\�4
it U
City:�� Stat � Address: � �'a�c,
Zip Code: 3g0k1ra Fax: City: �`'� PVQe State:
Phone No. Zip Code: ����g� Fax: q7a LV
E-Mail: Phone No ��a` quk- - f
Fill in fee simple Title Holder on next page(if different E-Mail «,� LI F � C�
from the Owner listed above) State or County License t�m\ L
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEME TiAI CONSTRUCMTENLIEN LAIN NNRMATI N:
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 ap'plicable 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
commepicipg work or recording our Notice of Commencement.
lti.r. hilt,"1'•
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Signatur of Owner/Lessee/gontractor as Agent for ;, er•;F°; Signature ontractor/License Holder
STAT OF FLORIDA , rn< STATE F FLORIDA
COU' TY OF COUNTY OF �o
The forgoing instru nt was acknowledged before (i ji�= The fo going instru nt was acknowledged before me o.
this day of 20by sg this day of 20,�'by
�a— u � � oA<
N m of person making statement. "' Na of person making statement. �N
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of I enti a io Type of Identifi do
Produced Produced
(Signature of otary Public-State of Flor a) (Signature of Nota ublic-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.