HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
r
[ation
ECEIVE®
� r
Building Permit Appli DEC 1 9 2018
Planning and DevelopmentServices mitting Department
Building and Code Regulation Division2300 Virginia Avenue,Fort Pierce FL 34982 . LUCie C nty, FL
Phone: (772)462-1553. Fax: (772)462-1578 Commercial esl en .
PERMIT APPLICATION FOR:
PRQPOSED INP NVEMEN T CATION:
Address: 4-O f— t--f Y-NP.T-r—p . L �f n1 d►
Legal Description:
Property Tax ID#: - '�!k46'n - eOt - of a — d00 Lot No.
Site Plan Name: Block No.
Project Name: r-,y a>-
Setbacks Front Back: Right Side: Left Side:
DETAILED DESS* +IPTIONF WOR
go 0 OQ 4P-4
CC'3 STRUCTIO INFORM TION:
itlonal worK to be pertormeci uncler trus permit cneCK all tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: f2 R Sq. Ft. of First Floor:
Cost of Construction: $ , bC�� Utilities: —Sewer _Septic Building Height:
W1507/1110-8-19E: COINS TR COITLO :
Name—,-kp r -e1,. C') • ; 1-0 enr, Name:
Address: '**?06'Y-.►r-sem Company:
City:,F� a 'ZE' , / State: ` Address:
Zip Codet YC?8 a Fax: City: State:
Phone No.";'Cpl -3 �O -SAF �igZ 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.
WIPFLEMEN AL CONSTR Cl" ON L{;EN LAW {, (3RMAT{QN:
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 'encement.
Si ture of Owner/ essee/Contractor as Agent fonc Signature of Contractor/License Holder
STATE OF FLORID 17-2 map
STATE OF FLORIDA
COUNTY OF 9?U) COUNTY OF
UW
'9 nZC
The for oing instrument was acknowledged-before �T= The forgoing instrument was acknowledged before me
this j day of_:2> IP-<'—' 20La by o:!Q this day of 20_ by
ro
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of I - fic tion Type of Identification
Produced C_• Produced
(Signature of NotbJy Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.