HomeMy WebLinkAboutBuilding Permit ApplicationSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MO TGAGE COMPANY: Not Applicable
Name:
_
Nam
Address:
A d d r
City: State:
ity: State:
Zip: Phone
ip Phone:
FEE SIMPLE TITLE HOLDER: _ Not Appl ca
B D G COMPANY: Not Applicable
Name:
N\ae:
Address:
Aess:
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 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 oCjecD4ding your Notice of Commencement.
ractor e se Ho der
tigwrf 0 ner esse ontractor as Agent for 0
STATE OF FLORIDA
COUNTY OF 'LlArrid
STATE OF FLORIDA
COUNTY OF
The for oing instrument was acknowledged before me
thisy� day of TDI t 20LR by
The forgoing instrument s acknowledged before me
thisM day of ��T 20n by
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Name of person making statement
ersonaIly Known ✓OR Produced Identification
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Name of person making statement
Personally Known k.I OR Produced Identification
Type o enti ication
Produced
ype o Identification
Produced
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(Signature of Notary Publi
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Commission No. 1 r—� 14�
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; , MY-%GMMISSION # FF987
EXPIRES April 27, 2020
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mmission No.�'I `��% ` Y •.� Pa ALL TADLEY R
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REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� Permit Number:
- Building Permit Application
Planning and Development Services
Building and Code Regulotion Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential A
PERMIT APPLICATION FOR: lectrical
PROPOSED IMPROVEMENT LOCATION:
Address: 12611 C.INWAM►{ VIA4 _ RA( CTv 6. 34g(10
,
Legal Description:
Property Tax ID #: - d ' Lot No.
Site Plan Name: Block No.
Project Name: Tt-m1VF1Li% Y'yic 1W V T1 1
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
��CQIr'Cr, �".�P.Cv�\TS �Oif��USC1fc. �l�S1f� �•1�IC�Ok1,A�F, . 12E.p�,P�CE.�E,t� riC.f��
tic1l4-.vJ . ALL Ctk w-cRt{ ���RlAG I EILIST 14G,. do ,cklLoAb.
CONSTRUCTION INFORMATION:
Additional work to he oertormed un er t is permit -check a apply:
F1HVAC Gas Tank Gas Piping Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers ❑ Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 0 ,'DI1 Utilities: Sewer Septic Building Height:
1
OWNER/LESSEE:
CONTRACTOR:
Name 7c
Name:
Company:
Addres
Address:
City:"State: F(—
Zip Code: Fax:
City: smgo= State: �L
Phone No.
Zip Code: Fax:
E-Mail:
Phone No. 7112. � 2. ' Oq 32
Fill in fee simple Title Holder on next page ( if different
E Mail: i���Ci�('►c1�l1CC,C'I(`(�S� De}
from the Owner listed above)
State or County License: c��Z
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.