HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED,FOR APPLICATION TO BE ACCEPTED 0, ) '
Date: Permit Nu
_E
7RECENLU
Building Permit Application. . AUG 7 2019
Planning and Development Services Pe I'I'n'I ttl n g .Department
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL-34982 - St. Lucie unty, FL
Phone: (772)462=1553 Fax:(772)462-1578 Commercial Kesi ential ,
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT.,LOCATIO_N , ,.
Address:
Legal Description:
Property Tax ID (}(7lli ood •'4 Lot No.
Site Plan Name: Block No.
Project Name:..
Setbacks Front Back: Right Side: " Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
itiona1-work to be nerformed under this permit—c ec .a appy:
11HVAC E]Gas Tank, ❑Gas Piping Shutters Q Windows/Doors
Electric Plumbing Sprinklers .Generator E] Roof Roof pitch
Total Sq.''Tt;'of Construction: S of First Floor:
Cost of'Construction:$ 'i5 S"0 Utilities: of
Septic Building Height:
OWN�ERAESSEE: -. CONTRACTOR:
Name,..lN°I.0Name:," 'Cfrr� �e �✓�,..
Address: 42 S "d,, Company: LJC;e vl_
City: d Id State:TO Address:. j u-y
Zip.Code: 3 -71'3 Fax: City: State:
Phone No: Zip Code: 3y S 'Y7 Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on;next page(if different E-Mail: IWto/ rte,
from the Owner listed above) State or County License:. ��l 33 0
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIENLAIN 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'.
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 thepermit 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 o.n.the jobsite
before the first inspection. If you intend to obtain financing, consult with fender or an attorney before
commencinR work or recordu*ng your Notice of Commencement.
Pv
Signature of Owner/Less e /Contractor as Agent for Owner Signature of Contractor/Licen a Holder
STATE OF FLORIDA �¢ �`�� STATE OF FLORIDA
COUNTY OF L COUNTY OF
The for oing instru ent w s acknowledged before e's'4bb The fo oing instru ent was acknowledged beforeH�9O
this day of �J�� 20� by �1�0 this dayof 20� by`10
Name of person making statement ;.0 n.a Name of person making statement PersonallyKnown V OR Produced Identifica taP° �� Personally Known Ir OR Produced IdentificatiType of identification NQ Type of IdentificationProduced °f-g° ProducedN ,) DD°
H a
(Signature of No ary Public-State of Florida) °' (Signature of Notarl Public-State of Florida)
Commission No. 4G Ig G (Seal) Commission No. 6, (Seal).
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER- REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW;
DATE
RECEIVED -
DATE
COMPLETED
Rev.8/2/17