HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APRLI,CABLE INFO MUST BE COW,) `1 eu rOR APPLICATION TO BE ACCEPTED
Date: _� Permit Number:
Q_ ,A� RECEIVED
*w.w, ...: Building g Perm t Ay Application
FEB 0 2018
g pp ST. Lucle County, f�ermitung
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:
?R(.?POSQ (NPROVEME111 I�QCATIo�
Address:
Legal Description: e
Property Tax ID #: T�fyi,�z�l��,®,f --!`s Lot No._
Site Plan Name: Block No.
Project Name: rtlw �1�
Setbacks Front,/ Back: _� Right Side: Left Side: A;9�
pertormed under this permit— checK all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers —Generator
Total Sq. Ft of Construction: �%�� '_Sq. Ft. of First Floor: _
Cost of Construction: $ C%. /err Utilities: _ Sewer _y�tic
Nameyr,f��
Address: , fi4'-3P_ 'I,
City:a�i-z�&::� State:
Zip Code: Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Windows/Doors
Roof Pitch
Building Height:
Name:
Company:1��
Address: y
City: State:L�;
lip Code: �L/?�7` Fax:
Phone No ts:_
E-Mail' ��.rr��lyn��srlfitnrda7�r�.
State or County License—
If value of construction is 2500 or more, a RECORDED Notice of Corn
DESIGNER/ENGINEER:--
_ Not Applicable
MORTGAGE;COMPANY: _ Not Applicable
Name:---
., ,
Name: .
Address':..:.."--' =
I
Address:
City:
State:
City: State:
Zip: j Phone
`� '�
I
'Zip: Phone:
_FEE_ SIMPLE TITLEHOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: ..Phone:
Zip: Phone: I
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 lof Commencement must be recorded and posted on the jobsite
before the first'inspectio.n. if you intend to obtain financing, consult with:lender or an -attorney before
commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged befo le me
this day of 20_ by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identific I ition
Type of Identification
Produced
Commission No. (Seal)
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of 1 20_ by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced
Commission No.
(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REV
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
I
/
COMPLETED
Rev. //LU14
'CERTIFICATION:
This application is hereby made to obtain a permit to do the work and installations as indicated, and to obtain a certificate of capacity,
if applicable, for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all
work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
may be required for ELECTRICAL, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS,
AND AIR CONDITIONERS, ETC., not otherwise included with this building permit application.
The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non-
residential use.
NOTICE TO OWNER: FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO
OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE TO APPLICANT: AS THE APPLICANT FOR THIS BUILDING PERMIT, IF IT IS NOT YOUR RIGHT, TITLE,
AND INTEREST THAT IS SUBJECT TO ATTACHMENT; AS A CONDITION OF THIS
PERMIT YOU PROMISE IN GOOD FAITH TO DELIVER A COPY OF THE ATTACHED
CONSTRUCTION LIEN LAW NOTICE TO THE PERSON WHOSE PROPERTY IS SUBJECT
TO ATTACHMENT.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance
with all applicable laws regulating construction and zoning.
rl>7--85�2 ��=- ( �' A
lam_
O R OR CONTRACTOR SIGNATURE C&TRACTOR S T RE
STATE OF FLORID ,
COUNTY OF
The foregoing instrument was acknowledged before
me this day of% 20
by
who is personally known or who has produced
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged before
me this : day of 4 , 20 ,
bywho is personally known who has produced
as identification. as identification.
Signa Nota Signa a of ry
o Notary of FbridO
Commission No. reden � Commissi , swe dorm*
My Commisafoe GG 0878665 =k* E Adams
j« Expires OW28=21 My Commission GG 0876%
or Expires 03128=21
NOTE: TWO (2) SIGNATURES ARE REQUIRED. EACH SIGNATURE M ST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT, AS AN OWNER/BUILDER, THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUH,DER APPLICANTS.
For specific instructions see appropriate permit checklist.