HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J
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Date: FS"ol� � _ Permit Number: /
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_ Building Permit Applic Mon AUG 2 3 2018
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982 . L CI U f")hyo FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Reside
PERMIT APPLICATION FOR:
PR.OROSED��LLNPR017ENIENT LOCATION:
Address:_
Legal Description:
Property Tax ID#: t 1? '50d , 0/ YV I- Lot No.
Site Plan Name: Block No.
Project Name: xy p �cxL SS )PS
Setbacks. Front Back: Right Side: Left Side:
1=0@004111'jiP Q,N OF W0 �K:
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CONSTR'1Y., N INF JRMAT(O
Additional work to be performed under this permit-check all that appy:
_Mechanical _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: $ �911_�)7r dU Utilities: —Sewer —Septic Building Height:
FIRMA, ER/LE=-5SEE: C®NTRACTOR•
Name Name: CA e
Address: �� Company:
City: State; Address: o 3-
Zip Code:,3c(�i dr �'� Fax: City: P �-� �p State
Phone No. Zip Code:?c4ci 0 Fax:
E-Mail: Phone N, -7 fii7l 001
Fill in fee simple Title Holder on next page(if different E-Mail s
from the Owner listed above) State or Cou y Licens 1
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CQNS'TRUCTIONN Mw�Wl 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 the permitholder 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 financing, consult with lender or an attorney b
commencingwork or recordingour Not a of Cip mencement.
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Sig ture o caner/ ssee/Contractor as Agen Sig ure•of Co tractor/License Holder = z
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STATE OF FLORIDA o oa STATE OF FLORIDA o o¢
COUNTY OF ¢"w m COUNTY OF <}w
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The for oing instrupnfrit was acknowledge fo e, ie:�as The,fWoing instrupaept was acknowledged fo oeoti.;
this day of 20y =� thiS day of ' 20y
*„fit' � "'•,t.�fit,
Name of person ffiaking statemen . Name of pers& making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identifica ion J n
Produced �' Produced
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(Signature of Nota y ublic-State of Florida) (Signature of Not Public-State of Florida)
Commission No. (Seal) - Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW ' REVIEW
DATE
RECEIVED
DATE
COMPLETED
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