HomeMy WebLinkAboutBUILDING PERMIT APPLICATION8(CANNED
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 ' 1 -1 90J Permit Number:
RECEIVED
Building Permit Application JAN 2 6 2018
Planning and Development Services
Building and Code Regulation Division L ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential _ e
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
„PROPOS.ED:IMPROVEMENT.LOCATION', v
Address: J dcl Pill r v`U
Legal Description:
Property Tax ID #: , IJ VJ "�� 7/ -, (OU �OU�/ =,7 Lot No.
Site Plan Name: n r��� Block No.
Project Name•%�ff%'/R.f r�,lc7�:
Setbacks FrontI 0��!7 ack: .3ight Side: � 3Left Side: a
DETAILED DESCRIPTION OF WORK
om 07#11 Tf-7 .4r- 07YU or1/
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CONSTRUCN INFORMATIO TION
Additional work to e e orme under this permit - c ec a apply:
L&HVAC Ei Gas Tank ❑Gas Piping _ Shutters a Windows/Doors
lU Electric � Plumbing ❑Sprinklers Generator ® Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Flo r:
Cost of Construction:$ 100 Aa0 Utilities:SewerSeptic Building Height:
:bwN ER/L ESSEE:
CONTRACTOR.,
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Name
Name: A, u%
Address:
Company: (�� G• '
C41
ity: State: f rL.
Address: -
Zip Code: Fax:
City: - State&_
Phone No. 71
Zip Code: Fax:
E-Mail: RoL
Phone No. `
Fill in fee simple Title Holder on next page ( if different
E-Mail• -//
State or County License: v
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEWLAW IN
DESIGN EN, INEER: _
Name: G
Not Applicable
AA/ -@
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:61
State:
City: State:
Zip: Phone -
-77P
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _
Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City: ILL I
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 vour Notice of Commencement.
A
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Signa ure er/ Lessee/Contractor as Agent for Owner
tig4tufe 8f Contractor/License Holder
STATE OF FLORI
COUNTY OF Li_)'01
STATE OF FLORIDA LrV�
COUNTY OF+
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The forgoing instrument was acknowledged before me
The for tng instrument was acknowledged before me
this Sway of t� a 20 J_�by
this ay of �Q,+�y� W , 20J r by
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Name of pers making statement
Name of persoh king statement
Personally Known OR Produced Identification
Personally Known I OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Sig
(Signature
of Not ublic- State of Florida )
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WE.NANCYW.ARLEDGE
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DATE
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DATE
COMPLETED
tev.8/2/17