HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
^ T � RECEIVED
1 APR f `2 2 018
Building Permit Application Permitting Department
St. Lucie County
Planning and Development Services
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:
PR(3POSED IN.P1 Ql/EM 'NT LidDCATIC}N5
Property Tax ID #: i�lo�Q�Q�n Lot No.
Site Plan Name: Block No.
Project Name: L ULNX5 VQ5k[A:Ra112A_-
Setbacks Front Back: Right Side: Left Side:
rmeci under this permit- cnecK all tnat app
✓ Mechanical _ Gas Tank _ Gas Piping
v ectric Plumbing _ Sprinklers
Total Sq. Ft of Construction: s�
Cost of Construction: $ oo C Utilitii
_ Shutters ✓Windows/Doors
_ Generator ✓Roof Pitch
Sq. Ft. of First Floor: /
S: _ Sewer ✓Septic Building Height:
0111/N E.R/i.ESS E. p
CONTRA TQR: mq n 5
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Name Max 44&drd�
Name;. , W -%A)
Address:
Compa ny:
City: T 12i'e. .e.. EL- State: _
Address:
Zip Code: Va- Fax:
City: State:
Phone No. 77-2 - ,2 3%- &a 04. 1 • =!J 1?2-1 I
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
SUPP�EM , IX CONSTRucT10 LIEN Aw INFORMATIQ �
�
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, lAo hereby;agree that Iwill n"all-respects, perform -the work
in accordance with the approved plans, the Florida Building Codes and St:•Lucie County Amendments. I
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_u'ses to anothernon=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 attofney before
commencing work or recordin ..your Notice of Commencement.
XL Lg=� L2�
Signa ure o ne / L ssee/Contractor aFA*g—efft for Owner
Signature of Contractor/License Holder .,
STATE OF FLORID
STATE OF FLORIDA
COUNTY OFF �/U Gt 2r
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledg efore me
this.rft4day of �-� , 20•j by
this day of _ by
(Name of person Uknowledging)
Agn
(Name of person acknowle ing )
ure-of Notary PublicbState of Florida.),
(Signature of No ry Public- State of Florida )
Personally Known OR Produced Identification
Personally K wn OR Produced Identification
Type of Identification
Type of Id tification
Produced
Produce
6-0=(9eaIjPHNAINGRAM
Commission No. ,,,,
Commission No.,`-''. i... (Seal),.
•�
Notary Public - State of Florida
Dec 20. 2018
s
R v Comm. Expires
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DATE
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RECEIVED
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DATE
COMPLETED
Rev. 7/2014