HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l
Date: ��(1 5 IP Permit Number: \$ J d -b J
RECEIVED
- OCT 17 2018
Building Permit Application
ST. Lucie County: Permitting I
Planning and Development Services _
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 123 44o65_0t ``
Legal Description: aia-f it r�R '7g — U,n,t koA/af Loi 3d
Property Tax ID#: 005 DoO—"24 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit—c ec a appy:
HVAC E]Gas Tank Gas Piping Shutters Windows/Doors
❑Electric ❑_Plumbing O Sprinklers MGenerator Roof Roof pitch
'Total Sq. Ft of Constructio :Aco Sq.a S . Ft.of First Floor:
Cost of Construction: $ _ Z60�Utilities:-Sewer Septic- Building Height:
OWNERAESSEE: CONTRACTOR:
Name n.)...i-iz b),felp,r Name: 'e
Address: 1)01 Company: �S�orP�lf�n P. 0/ a///l A
City: F�', rfrrG Stater Addres J�7.� -�• �'C?A d S7-
Zip Code: 3i-�a� � Fax: City: I")C'`L State*-
Phone No. Zip Code: N, TL_7 Fax:
E-Mail: Phone No. 615
Fill in fee simple Title Holder on next page(if different E-Mail: co
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW 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 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
commeDang work or recording your Notice of Commenceme
Signature of Owner/Lessee/Contractor gen for-Owner. Signature of Contractor/License o der
STATE OF FLORIDA STATE OF FLORID
COUNTY OF 5�'• �-v C COUNTY OF Q
The forgoing instrument was acknowledged before me The for i g instr e t N as acknowledge before me
this day of 6 20 [_� by this�ay of 20l by
Name of person making statement Name of pers n maUg g statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced L L Produced
hwcjv�I 0
(Signature of Notary P tic or NAIE GIVENS (Signature of f)t)
Public-
State
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17