HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONC
All APPLICABLE INFO MUST BE COnnrLETED FOR APPLICATION TO BE ACCEPTED'
Date: Permit Number:
RECEIVED
Building Permit Application AUG 2 4 2017'
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
I
PERMIT APPLICATION FOR: *��Xzv'6
I PROPOSED
1@1 MEW! NSIBROM48 0 IN NSITHEMONTIORNS
Address: III --3q5 9 XV �' --r-
Legal Description:
Property Tax ID Lot No.
Site Plan Name: Block No.
Project Name: q4V-11*'/JJ'4R 1106;
Setbacks Front Back:
-r
Right Side: Left Side:
ditional work to be perrormea uncier tnis permit— cneCK all tnat apply:
—Mechanical — Gas Tank — Gas Piping — Shutters Windows/Doors
— Electric — Plumbing Sprinklers — Generator Roof
Total Sq. Ft of Construction: 4 Sq. Ft. of First Floor:
Cost of Construction: $E J Utilities: —Sewer _Septic Building Height:
Name sw4-9
Address: a '# Vf:r
4q—� go 'r
City: ' ke f Stat0f=
Zip Code: 947 Fax:
Phone No.
E-Mail:
7
Fill in fee simple Title Holder on next page if diffe.rent.
from the Owner listed above)
Name:
Company:
Pitch
Address"'-,
ci x"rWV14"
4. �k, State:
Zip
..,Code:
Phone Not—
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENT L CONSTRUCTION LIEN LAW INFOR+MATtOE
DESIGNER/ENGINEER: _ Not, Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: s
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not;Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address: 4
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, 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 our Notice of Commencement.
,Signature�of�wner/ Lessee/Contractor Agent for Owner
,;. —. =� �
Signature of Contractor/License Holder
STATE OF FLORIDA i
COUNTY OF
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged bef6 re me
this a'�day of ton byl
k
The forgoing instrument was acknowledged before me
this day of 20_ by
I
9 , .Q a Jx ZLai� I
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Publi State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification 3
Type of Identificat n
Produced
Personally Known OR Produced Identification
Type of Identification
Produced
Commission. No. (Seal) I
����.�rrw„� LASHAHNA INGRAM
Commission No. (Seal)
REVIEWS
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PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
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RECEIVED
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DATE
COMPLETED
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