HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO QMPST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0 Permit Number:
RECEIVED
Building Permit Applicatio
NOV 14 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
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
PROPQSED IIUIPROVEM,ENT LOCATION ,3, - .n,
Address: 1 -7 i
Legal Description:
Property Tax ID#: 0(972— Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
CIETAILED DESCRIPTIQN OF WORK f- k "
CONSTRUCTI�QN INFORNtAT[ON
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Additionalwork to be oertormed under this permit—check a appy:
NHVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
S
Cost of Construction:$ Utilities: _Sewer ElSeptic Building Height:
QWNER/LESSEEi OR ,
..
Name Name: 2
Address: Company: 01,-) -AL Q
City: I State: Address:
Zip Code: '3��J(z Fax: L/L City: +tfiylnnnn Stater
Phone No. L py Zip Code: _Ap Fax:
E-Mail: Phone No. 95LL �_12_7 1 ot?-a
Fill in fee simple Title Holder on next page(if different` E-Mail: ()(LVRWQ
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 (. INFCIRMATION
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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 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 Com encement must be recorded and posted on the jobsite
before the first inspection. If you intend to obta' financing,consult with lender or an attorney before
commencingwork or re din ot,-"ce o ommencement.
uk��_Signature LFLO
r/Les�e/CqKtr4actbr,,as A or Owner Signature of Cont
�ct•r/L'tq�p =HUI-er
STATE O STATEOF FLORIDA �n ^A
COUNTY OF D ) COUNTY OF 15 MA�
The for o fg inst megga, s acknowledged before me The forgoing instrument was acknowledged before me
thisclay of (�f7J ,Z.- 20a�by this L�day of( C7"Lrdf3 � . 20� by
r�r pis h �llear u�� c�D�n S' 1�'�
Name of person making statement Name of person making statement
Personally Known OR Produced Identification X_ Personally Known OR Produced Identification X.
Y,
Type of Identification Type of Identification
Produced �/L/d�%L� ��( t�f1�P Produced Pt_5.S (`fid
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(Si nature o Notar Public to I a of Flori (Sig ature of N P I'c- t o I r'
ipRY a,'y 2'Z. I3ARLEN,.(.t .oma?!?p,c; DARLENE HA,'��jjON
Commission c� Commission No. = OMMISSId `OG023966.
EXPIRES:September 9,2020 0= EXPIRES:September 9,2020
Bonded Thfu Nota Public Undervvriters 'j�OFF`OQ' Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
--DATE
DATE
COMPLETED
Rev.8/2/17