HomeMy WebLinkAboutBuilding Permit Application All APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: / Permit Number:
a, L RECEIVED
Building Permit Application AUG 2 9 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue,Fort PierceFL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential ix
PERMIT APPLICATION FOR:
PRQP�SED INPROUEMENT L®CATIC}N:
Address: r 7 c.f
Legal Description:
PropertyTax ID#: °�y��^ 5l10- OATS_ Odd^ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
ETAILED DE�SCRI'PTtON 4f WORK:
e s�'��ce %s� 'fir®n ',�` /,.�d.� Zle ales 2 c�/c�o Z ,� ��
f�ONSTRUCTION t.NFO'R+MATIQN:
itiona wor to a per orme un er t -is permit-checK a 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:$ fUtilities: —Sewer —Septic Building Height:
r a
OWNER�LE=SSE CONTRACTOR:
Name �ad� Name:
Address: /15/0 ;-5 A w 4,e Company:
CitState:L"Z Address:
Zip Code: Fax:Fax: City: State:
Phone No. '77 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.
cul
u PLM 0C LONA TO C I"N t_ �N W 1 °'t f MATtQN:
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 authorise 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
commencing work or recording our Notice of Commencement.
�1, nature of er/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledgegbefore me The forgoing instrument was acknowledged before me
this DON- 4S
day of n ,20� by this day of 20_ by
Name of person makingTtement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identif—atC*o2n Type of Identification
Produced °r Produced
(Signature of Notary b i - NpMpRIE HENS (Signature of Notary Public-State of Florida)
..........u DFS #GG 022o23
Commission No. YCOMMISS ihs 2020 Commission No. (Seal)
De�
r, :o Nclary Public UndenNritets
Bonded ThN
.EOFF�
REVIEWS FRONT ZONING . _SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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