HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: \T Permit Number: \0`(3) C)
F RECEIVED
Building Permit Application JAN 0 4 2019
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: w�� Al
P ��POSE9ENT LC*?CATI9 ` W.
Address: V •^ ` EZ-
Legal Description:
Property Tax ID#: a�a. 1" �odrP � Od46 -4C10- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
12
DETAILED DE-�S R+ PTION + WORD ,
CO STRUCTIO NFC1R IQN.
Additional work to be pertormed under this permit—check all that appy: i
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
o�
Cost of Construction:$ Utilities: --Sewer _Septic Building Height:
INEWNIN IELE�5SEE: ONTR tOR:
Name Name: . ,
Address: Company: -
City: o er State: Address:
Zip Code: / Fax: / City: State:
Phone No./7�2) 4A 7— to /A 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.
S 1110, NT` L CONSTR� CTIQN 'N LAIN ! i'{«�RMATlON:
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 concurrencyreview: 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.
Sign af ur of Owner/L see/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The going instrument was acknowledge before me The forgoing instrument was acknowledged before me
this� day ofJA-f\ 20 I by this day of 20_ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced 3D L Produced
(Signature of Notary P lie:5 :of F � SSION;i66 2023 (Signature of Notary Public-State of Florida)
EXPIRES:De Amber 10,202§
Commission No. Bonded Bondedrmsl#rypublic Underwtiters Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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