HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMP'' i CL'D FOR APPLICATION TO BE ACCEPTED r
Date: sS - 7 Permit Number:
Building Permit Application FEB .7 2018
Address:
Legal Description:
Property Tax ID #: 35 2- - ] 3 9 " 0
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
ionai worK •
Mechanical
Electric
rmea u
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Q«
—Gas Piping
Sprinklers
an tnai appry:
Shutters
Generator
Sq. Ft. 'of First Floor: _
Lot No._
Block No.
Windows/Doors
Roof S/'0_ Pitch
Utilities: _ Sewer _ Septic Building Height:
Name i_ aJ-e/\
Name:
Address: W V (dc,o ApIG C"
Company:
-
City: 1 jd24 aP rGte State: 4f
Address:
Zip Code: Z Fax:
City: State:
Phone No. ? Z) 2 3 u
Zip Code: Fax:
E-Mail: ' GIPQA M Ar it •
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.
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DESIGNER/ENGINEER: — Not Applicable
MORTGAGE COMPANY: Not Applicable
-'Name:..-
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: —Not Applicable
Name: Name: i
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I
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 on 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 co, currency 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 Commencemlent may result in your paying twice for
improvemen our property. Notice of Commencement must be recorded and posted on the jobsite
before the rst)ns ion. If y /intend to obtain financing, consultlwith lender or an attorney before
commenci wo r recordi ' our Notice of Commencement.
Sig n�ero _ L see o a o or Owner
Signature of Contractor/License Holder
S OF FLORI -
STATE OF FLORIDA
C UNTY OF
COUNTY COUNTY OF
The forgoing instru nt was acknowledged -before �A% ;;;;t,°
this � day 20H by
The forgoing instrument was acknowledged before me
day of
of g
this 20_ by
am
tnC
(Name of person acknowledging)
�$
(Name of person acknowledging)
oA
(Signature of o ary ublic- State of Flori )
(Signature of Notary Public- State of Florida )
Personally own OR Produced Identification
Type of Identifi ion
Personally Known OR Produced Identification
Type of Identification
Produced f
Produced
Commission No (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
I
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
1
RECEIVED
DATE
COMPLETED
ev.