HomeMy WebLinkAboutBuilding Permit Application All APPLICABL I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Y f'�• Permit Number:
Building Permit Appli ation AUG 2 3 2018
Planning and Development Services
Building and Code.Regulation Division Pe r.m I Lti n g De atm
2300 Virginia Avenue,Fort Pierce FL 34982 U I `� U Il��r/o FL
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Phone: (772)462-1553 Fax: (772)462-1578 Commercial lag]___._._
PERMIT APPLICATION FOR: -
PROPOSED 1N``PROVEMENT LO.CATIC#N
Address: (o
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
m
Setbacks Front Back: Right Side:� Left Side:
DETAILED DEQ IPTION OF-W4111<
t CLy x
COIISTRUCTION'INFORIVIATION
Additional work to be pertormed un er t ms permit-check all that at 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:$ V Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE C{�NTRACTOR
Name ', 1 Name: — ,, LL �tJ �i/ S�4ay
Address:�pLI(o i� W12 bc� Company: 'Deg k w 1-��w
City: ey-ce Stater Address: L✓WO1V A//k_l10iy '4f/0—
Zip Code: L )- Fax- City: State:E`A
Phone No. 7g� 7 Zip Code: Fax:
E-Mail: Phone No ,7�
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.
SUPPI.ENiENT4LCONSTRUCTlON �.fEN LAIN INFORMATION
... / pp MORTGAGE
,,....v �,,...
DESIGNER ENGINEER: _Not Applicable E 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 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,
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
commenc
Mgwork or recg_rding your Notice of Commencement.
Signature f O ner ontractor as Agent for Owner Sign a Con actor ense Holder
STATE OF FLORIDU1'�'*` � STATE OF FLORI Aar*Nps'_
COUNTY OF -
COUNTY OF
f
The oing instr ent was acknowledged be re mg The forgoing instru was acknowledg be rp
this day of 20I b a x g this ;��Iay of 20 b Xoo v
a�g 9 2 mom"
Nu,'�
m
(Name of person Acknowledging (Name of person acknowledging) °N1�'T pm
a � a
(Signature of& taryPublic-State of Florida) (Signature of N t ry Public-State of Florida)
Personally Known 7 OR Produced Identification Personally Known` OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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
Rev. 7/2014