HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: I ��' Permit Number: n4�
^� - 7 RECEIVED
_ Building Permit Applicati n DEC 2 7 2018
Planning and Development ServicesPermitting
Building and Code Regulation Division ST.Lucie County,
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Q)4e4Y
PRC ` QED P t7VEMF E€CIA .
Address: C 06-9
Legal Description:
Property Tax ID#: ZY02 : Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Additional work to be pertormed under this permit-check 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: $ ;/ �J• � Utilities: —Sewer _Septic Building Height:
Name /11r, Name: - _ -- --
Address: (003 T&6G 1_0 �If n Company,:
City: C7 P7_L-off L� State:J Address:
Zip Code: 3'I i 0 Z- Fax: City:_ - - State:
Phone No. 7 7 Z ¢G� -C1 � Zip Code: Fax:
E-Mail: I?trn F[L OL COM 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.
a• OR, CC±3 Ci' t M
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 herebiy 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.
Sig to a of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFra COUNTY OF
TheIn
for oing st ment was acknowledge before me The forgoing instrument was acknowledged before me
thiso day of 204A by this day of .-20_ by
\J �ko G
Name of p rson making statement: / Name of person making statement.
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identif' Type of Identification
Produced ion Produced
I AA
(Signature'of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. K N S. NIELSEN ommission No. (Seal)
ss State of Florida-Notary Public
My co. n1issi6n Expires
REVIEWS FRON- JueSUPERMSOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER EVIEW REVIEW REVIEW REVIEW
DATE
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DATE
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