HomeMy WebLinkAboutBuilding Permit Application OCT/08/2018/MON 02:51 PM FAX No. -P• 001
ALL APPLICAB E INJO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1pwq Permit Number:
OCT 0 8 2018
" Building Permit Application
Planning and Development Services Py Fy'I� IF no
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1579 Commercial Residential [f
PERMIT APPLICATION FOP-
Address:
Legal Description: ` a Z2 -
Property Tax ID#: Lot.No.
Site Plan Name: Block No.
Project Name:.
Setbacks Front Back: Right Side:_. Left Side:
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6140m, ",
SIR
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����itiona wor to e e Orme un er is permp : .LJHVAC �GasTank Gas Piping Windows/Doors
Zectric ❑Plumbing Sprinklers ElGenerator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ _. utilities: Sewer Elseptic Building Height:
gg"r4
11 r
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Name Name:
Address: � Company: tl
a
City: State: Address: �.
Zip Code: �7 Fa City: State:
Phone No. / 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.
OCT/08/2018/MON 02;51 PM FAX No, P, 002
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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: W
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
commencing work or recording our Notice of Commencement.
SiAturewn essee C n ra or as Age for Owner Signature of C rac r/License Holder
STATE
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COUNTY OF 0 ��-��-(E`y UNTOY OFba✓1/ 1LS(�
The r oing instru nt as acknowledg fore me The f ing instru t w s cknowledgVby
efore me
this day of ,20by this, y of Za
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;angstateent Na o pe o o per ra
kingstatement
Personally own�OR
Produced Identification Personally Kn wn OR Produced Identification
or
Type of Identification Type of Identification
Pro Prod d
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(Si ature o otaFlu �" Si ture Notary Public- on
JACQUELIN pE(iRANt31S ; J UEI INE DEC3RAN I
pmrnission Np_ -�� ' MY COMIAMMON#FFS85898 gmmission No. �II38ION#FF985 9
EXPIRES July%2020 EXP ES July 14,2020
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(407)39&0153 Fle ialloteryServke.aom
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
CGUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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