HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �• Y• I Permit. Number:
SCANNED RECENED
BY
Bu-ildingiftrmit Application JAN - s 2018
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Lk�cr3-F
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID#: f (" (o1V-Q1R0-WQ-1 Lot No. /(0/
Site Plan Name: LBlock No. 1�cP
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side: Left Side:
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CONSTRUCTION INFORMATION:
Additional work to be performed -under ispermit-c ec a appy:
❑HVAC Gas Tank Gas Piping _Shutters Windows/Doors
Electric Plumbing Sprinklers FIGenerator J��Roof
Total Sq. Ft of Construction: �J'� I S . Ft. of First Floor:
Cost of Construction: $ U Utilities:Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ` Al(-01 e (
Name: 0-5
Address: C')( V-n
City: State: _
Zip Code: , 5L/95 Fax:
Phone No._11F5(, - '?9-7(0
Company:
h C .
Address: _7-A' E
�_l,
City: �yaV* State:
Zip Code: V� Fax:-77,-),�-77(o3
Phone No. -nv�
E-Mail: -
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
(5 . (_ a
State or County L ense: CCC
1360
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name: _
Address:
City:
Zip:
Phone:
_ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
State
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:_
Zip:
I certify that no work or installation has commenced prior to the issuance of a .permit.
Phone:
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
commencine work or recording vour Notice of Commencement.
s
_ Signature of Owner/ Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA `�, STATE OF FLORIDA
COUNTY OF_ _ QY71(� COUNTY OFi 6-Ht-)
The forgoing instrument was qcknowledged before me The forgoing instrument was acknowledged before me
this day of Z-�tCeM 00-K , 20 Ll by this 3 day of 20 'L�&_ by
),�.Y�r-�t`G�_ phi ►n l�,S�ti/�i ��(1 ��e.
(Name of person acknowledging) (Name ofarson acknowledging)
(Signatur)of Notary Public- State of I rid
lr
Personally Known OR Produce Identification��
Type of Identification Produced 1�—
Commission No. Q) (Seal)
Revised 07/ 15/2014 MY COMMISSION # GG91863
ep oF�0, EXPIRES: May 17, 2021
(Signat re of Notary Public- StA e o Florida )
Personally Known i OR Produced Identification
Type of Identification Produced
Commission
REVS&A RESTIFO
MY COMMISSION # GG91863
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