HomeMy WebLinkAboutBuilding Permit Application M
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED y
Date: Permit Number: 1' � ��' 0 (.
RECEIVED
_
Building Permit A I cationDEC 10 2018
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Planning and Development services Permitting Dep tment
Buildirig•and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie Cho ntyr FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Kesldehttal
PERMIT APPLICATION FOR:
Address: - eill0-
Legal Description: ✓� a
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Property Tax ID#: /���� �U l �' E� 7�— ad 6 — Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: LeftSide:
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Acicifti.nnal work to be pe orme un er t rs permit—c ec all that appy:
—Mechanical _Gas Tank —Gas Piping —Shutters Windows/Doors
Electric Plumbing —Sprinklers Generator _U/Roof low Pitch
Total Sq. Ft of Construction: / C20Z0 Sq. Ft.of First Floor:
.Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
Name I 150r\ Name: le W1 'n
Address: G v` Company: /6
W141 1-6-
City: .� State: Address:le1,5 41
Zip Code: Fax: City: Q.c fc v Statel�]�
Phone No. Zip Code: 31-4 q < G Fax:
E-Mail: Phone No
'Fill in fee simple Title Holder on next page(if different E-Mailn(7 4411,A
from the Owner listed above) State or County License G
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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 Commencem t.
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Si ture of Owner/Lessee/Contractor as Agent fo fiisr' Signature of Contractor/License Holder;;* '
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STATE OF FLORID a x c STATE OF FLORID,. m�
COUNTY OF COUNTY OF �o 0
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The for oinginstrument was acknowledged before b R z� The forgoing instru t was acknowledged bef c z
this day of Eli .20 by 91 �T s this�f�day of L 20� by �T
m um
(Name of person acknowledging) (Name of person acknowledging)
4A iy<
(Signature of No a Public-State of Florida) (Signature of Notary lic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identific io _f Type of Identification _
Produced -UI C Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014