HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 8� - 0 �J
Date: –14 Permit Num;Residential DEC 26 2018
Building Permit Applicatiomitting Oepartm
Planning and Development Services Lucie ent
.
Building and Code Regulation Division CO u n t�/r FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT-LOCAT ON: M
_
Address:
Legal Description:
Property Tax ID#: � Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIP_TION;OF WORK
� U
CONSTRUCTION INFORMATION:
itiona work to bfele orme un er t is permit–check a appy:
HVAC Gas Tank []Gas Piping _Shutters Windows/Doors
Plectric L_J Plumbing Sprinklers ElGenerator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.''of First Floor:
Cost of Construction: $ �" d V Utilities: _Sewer Septic Building Height:
OWNER/LESSEE: CONTRACT
R:
Name ' 011l -&1 - — ) Name: 9
Address: ZCompany:
A
City: Stater Addre
Zip Code: Fax: City: State:
Phone No. Zip Co2 Fax:
E-Mail:' Phone No. --
Fill in fee simple Title Holder on next page(if different E-Mail: 6t& eolg�
from the Owner listed above) State or Co nbi License: ® C D
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN.LAW'INFORMATION:
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:
i
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
comrWncing work or record'jng your Notice of Commenceme t.
,o // N :1!�1111 -
(6c'!4- 4� -7T
Signature f Owner/Lessee gent for Owner Sig tur o Contractor/License Holder
STATE OF
COUNTY OF 61VI
FLORID STATE. COUNTY OF—of➢,�� � X)
77
The forgoing instr ment was acknowledged before me The f r oing instr ment was acknowledged before me
this�day of 1 20)lby this day of 20L'by
IF a
G
f person—making stat ment Nana of person making staleWt
ersonal n OR Produced Identification Pe on I Kno OR Produced Identification
Type of Identification T e of Identifmation
Produced Produce
(Signature of NotaPu lic- ignature of Notary Pu tc
•"ir4 � ,; L ERTYA.KING lr:s:. ;,, LIB KING
Commission No.
• ISSION#GG 090638 mmission No. _.; ;.= MY 'SSION#GG090631s
EXPIRES;Mey 4,2021 ai EXPIRES:May 4,2021
. BV&d Thru PuNe Underwriters
s",;,„P v��°a•• PorxW T1w Notary Pub k U �aq�T�t°�`` ►IotarY
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17