HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED tt t
Date: Permit Number:
RE \I9VEV D
NOV 0
Building Permit Application
9 2017
PERiMITTIN'G
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential _L
PERMIT APPLICATION FOR:.
Legal Description:
Im"s K /1 M
Site Plan Name:
Project Name:
Setbacks Front Back:
a
Right Side:
_Mechanical _ Gas Tank _ Gas Piping
Left Side:
Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
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UiotakSgW Ft�gof�Construction: Sq. Ft. of First Floor: _
C - st5of Constructionn: $ 5, 0 0 Utilities:, Sewer !/Septic
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press: hbUt- lAJll()C�l_��fYICf C_ ukju1\1
pity: �� �� 1��'rC �. State: �L
ip Code: :?2�qD Fax: pf
hone No.
E-Mail: J` �YAY-O In Gam, ` tO M
Fill_in fee. simple Title Holder on nextVage ( if different
from he'O er listed above)
Name:
Lot No.
Block No.
Windows/Do�Pi
jRoof ✓__ - _,y (Z
Building Height:
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable"
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 or recording vour Notice of Commencement.
S�gnatureof$w;W Lessee/Co tyl
or as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The orgoing instrume t was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20�;,by this day of ,'20 ' by
'(Name of person acknowledging) 0 (Name of person acknowledging)
igna re of Notary.Public- SqNte of Florida) (Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifica Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.