HomeMy WebLinkAboutBuilding Permit Application AII;APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �1
Date: Permit Number: R l4 IN.3�
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Building Permit Applic tion OCT ® 4 2018
Planning and Development Services
Building and Code Regulation Division PCI"C"i 13=11 n] Department
2300 Virginia Avenue,Fort Pierce FL 34982 S • LUde,I • u U n ty, FL
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one: (772)462-1553 Fax:'(772)462-1578 Commercial R ' n idf—
PERMIT APPLICATION FOR:
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Legal Description:
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PropertyTax ID#: Id �$'��`I Lot No.•
Site Plan Name: Block No. '
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Project Name:
S,btbacks Front Back: Right Side: Left Side:
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itiona wor' to a performedun er this permtt�-c ec all tnat appy:
_Mechanical _Gas Tank -7Gas Piping _Shutters ✓Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ �u Q�� Utilities: _ Sewer _Septic Building Height:
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}4 �,n ev�lc, Name: t,•
Name 1 +. +�
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'Address: 8305' t,t4r;5 &112-66 , f' Commpany: �.:.., hit r'•r'
City: �'trEeri.� State: rL A� ressr
Zip Code: Fax: City: State:
Phone No. I �g,a Zip Code: Fax:
E-Mail: fel-1--tM KJ4140:1. 00k, 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.
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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 apermit will authorize thepermitholder to build the subject structure
which is in conflict with any applicable Home Owners Assoc ation rules,bylaws or an 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
commencin .work or recording our Notice of Commencement.
�ig—nature'oC6wrier/Lessee/Contractor as Agent for Owner• Signature of Contractor/License Holder-
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The f oing inst ment was acknowledged before me The forgoing instrument was acknowledged before me
this day of 206 by this day of .20^ by.
(Nam f person acknowledging') (Name of person acknowledging)
ature of Notary Public-StWe of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identific Personally Known OR Produced Identification
f6dQd
e of Identifi tion' • _ °�AHNAINGAr,'•�` Type of Identification
"i;' - Pub11c-Sta orida ,i Produced
L SN 4 .r.
. a, Notary' - ate o ExPlrpf I.-
Commis,
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Commis' My Comm.ExPir °` ' � �yqq� '' C mission No. (Seal)
.��°:; Fam ssion, '�.oS Jotary Pu u�, 1 t for da
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REVIEWS FRONT G3andec I&Ji IERVI-SOF AssJ�ANS VEGETATION SEA TURTLE MANGROVE
COUNTER �E�V W REVIEUV" ftEi'IEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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