HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: t (S Permit Number:
RECEIVED
Building Permit Applicati n DEC 0 7 2018
Planning and Development Services ST. Lucie County, Permitting
Building-and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential -V/"/—
PERMITAPPLICATION FOR:
Address: �• 1 l S �� y PI era �`
Legal Description:
00 o _ s'I
PropertyTax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left,Side:
On
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U '� DicuS
6 - on a r
outi
Add
itiona wor 'o rempmeTormed under this permit qcc eck all 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:$ LO S O D Utilities: _Sewer _Septic Building Height:
Name 1 Name:
Address: S� �,�(� I 111 IY' C' Company:
City: �,�(LQ State: IF Address:
Zip Code: 3A q51 Fax: ,\ City: State:
Phone No. 7��- 1-���- V�15 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.
r
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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 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.
Signature of Owner/Lessee/Contractor asnt for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The f oing'inst u ent was acknowledg efore me The forgoing instrument was acknowledged before me
this day of __,2011by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
4 AA
(Signature of Notary Public-State of Flonda) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
-Type of Identification Type of Identification
Produced Produced
Commission No. KAREN 3$"I)ELSEN Commission No. (Seal)
--State of Florida-Notary Public
P° Commission #GG 207484
.,,oit�o�•�` My - xpires
REVIEWS
June 12, ;Z OR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW . REVIEW REVIEW REVIEW REVIEW
DATE •
RECEIVED
DATE
COMPLETED
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