HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q v�
Date:
f cam( ) )' Permit Num o �o` op
RECEIVE[
Building Permit Application DEC 1 1 2018
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 cj u ie U n ty, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line g
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Address: �/(0.1 'N�cthy�c►-A.� iA► E3106 P
Legal Description: f.�L� l +>`[z�jUy� T"kerL 6t. tDw1 rJ i Ur✓a
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Property Tax ID#: \yt\-`�O 5- C�C.S R- ��O - Q Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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rtiona wor to e e orme un er t is permit-c ec a appy:
HVAC �Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ zip Utilities:li Sewer[]Septic Building Height:
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Nam Name: "D-ZAM Qvaivnckk -R.
Address://)D(i ZVI; Company: 11 tre, 4 cit,
City: 7L State:/`� Address: kk\ . p I Vr'\Q..
Zip Code: 361 Fax: City: Q, ►krrv'Ow-k State:10-.
Phone No.3!=1;2- J-711—V V 2 0 Zip Code:3 y-1 L N Fax:
E-mail: L. _ Phone No. 79c)-` SSS - 42-Z(o
Fill in feC simple Title Holder on next page(if different E-Mail: q FS CtKw ,U
from the Owner listed above) State or County License: LE3 19 q 91
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 thepermit 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/Lessed7coofactor as Agent fo wner Signature of Contractor/Lic nse Ho der
STATE OF FLORIDA, /� r STATE OF FLORI A
COUNTY OF Ci+1xK COUNTYOF Z- r--
The forgoing instrument was/acknowledged before me The for oing instrument was acknowledged before me
this day of ����;•,, 74 `20� by this T day off /.� r'vti� �� 20J&by
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Name of person making statement Name of person making statement
Personally Known_�OR Produc i Personally Known�X OR Produced Ide ,
Type of Identification Type of Identification
Produced =° Produced
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ignature of Notary Public-State of Flo i ('3 °y (Sig ature of NotaryPublic-State of Florida) 0 3. D
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Commission No.�6�SZSLC1� 1.)i a= Commission No. �� /rZ `}�� (Se N m
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REVIEWS FRONT ZONIN J�o r153RFE VISOR PLANS VEGETATION SEA TURTLE AIIILfDV
COUNTER REVIE _J#ZE W REVIEW REVIEW REVIEW REvit9l
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17