HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: • Lit ' �� Permit Number:
��, RECEIVED
ItsBuilding Permit Application MAR 2 6 2019
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line ,
Aei�_ I
RlIPP,OSED IMPROVEMENT LOCATION
Address: 0 5qAtfl,1fW.
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
CONSl"RUCTION INFORMATION
: .
Additional work to be ertormed under this permit-check a appy:
❑HVAC G s Tank Gas Piping _Shutters ❑Windows/Doors
Electric LSI Plumbing ❑Sprinklers F]Generator E] Roof Roof pitch
Total Sq. Ft of Construction:... S Ft. of First Floor:
Cost of Construction:$ r ��o 0 Utilities: Sewer E]Septic Building Height:
"'ClWNER/LESSEE �._ CONTRACTOR:
Name Q Name: �: '1i •r
Address: ,, Company: I
City: State: Address:T.
64" 6f
Zip Code: �` •Fax: >_ City: . 2 ' Statecl-
tof
Phone No. Zip Code: `�� Fax:7' 44
E-Mail: Phone N
Fill in fee simple Title Holder on next page(if different E-Mail:.P
from the Owner listed above) State or County License: Fd -�' . 0
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTR lCTl0N LIEN LAW INFORMATION
F
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.1 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 otice of Commencement.
S fg'rTture.4f Owner/Lessee/Contra ge nf for caner Signature F Contractor/License o r
STATE OF FLORID r STATE OF FLORID r.
COUNTY OF JAle I COUNTY OF -t
The:915c ing instrument was cknowledged before me The forgoing instr ent wasknowledged before me
this day of 1 20 by this ° day of �` 20 b
1
person makings tement erson maki g statement
P sonally Know OR Produced Identification ersonally Known OR Produced Identification
Type o i ication Type of Identificc�
U
d
XSignature re of N No blit-State of Flori
:4 �IBERTYA. ING
Commission No f MYCOMMISSION 638 . •'t'��':.h•% LIBERTYA.I 1
Commission N = eMMISSION# $38
"a• �o`: EXPIRES:May 4,2021
••;r Bio EXPIRES:May 4,2021
Bonded Thru Notary Public Underwriters +
,yg+•' Bonded Thm Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER.. REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17