HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETI"'
Date: Vo
'DR APPLICATION TO BE ACCEPTED
SCANNED Permit Number:
[BY
S4 Lucie CoUnty OR
JAN 2018
Building Permit Appli�a�I�p4fnkYj Permltttng
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
PERMIT APPLICATION FOR: � )&0441�
Address:
Legal Description:
Property Tax ID #: �� �a"' Ca
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side:
Left Side:
Additional work to be pertormea under tnis permit— cneck all tnat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Residential V
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: 2-8 lo4� I Sq. Ft. of First Floor:
Cost of Construction: $ 4 Utilities: _ Sewer _ Septic
Name--,r_Aa, 44_XA
Address: To "ns blID
City: State:
Zip Code: o Fax:
Phone No. C D
E-Mail: mmki 1- ceu1cl ai •ce
Fill in fee simple Ti a Holder on next page ( if different
from the Owner listed above)
Lot No.,
Block No.
_'Windows/Doors
Roof 11 Pitch
Building Height:
Name:
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.
StQPIEMNTA� �C}MVSTR-UCTlC}NLIEI LU1C �NFQRMATtON� & s 4
..........'.:.....8_ & ... �.�. _ e.'0. 't... a,b ........: �.., �. `s .� ^gP .' .re- , . ,sa4a .� n wl•. .P. � . ±.�rv',° §
DESIGNER/ENGINEER: I Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: I Address:
City: I State: City: State:
Zip: Phone ' I Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: I Name:
Address: I Address:
City: I City:
Zip: Phone: I 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 failurelto Record a Notice of Commencement may result in yourpaying 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 or recording our Notice of Commencement.
Signature wner essee Contractor as Agent for Owner
Signature of Contractor/License Holder
STA E OF FLORI A
$ L
STATE OF FLORIDA
COUNTY OF yc %
COUNTY OF
The forgoing instrument was acknowledge before me
'Jck�
The forgoing instrument was acknowledged before me
this � day of 20_ by
this day of 20_ by
I
'S C 'N 114.
(Name of person acknowledging)
(Name of person acknowledging) ,
(Signature of Notary ublic- State of Florida )
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification I
Type of Identification
Produced GIVENS
Produced
..... IX.Nph1ARIE
13
PU�'c�•
Commission No. �D" MyGG� �Ic�0N¢�GG02202
E;CPImbet�B�� �k16, 2020
Commission No. (Seal)
a_
�= Notary Public Undenvdtere
s+rFOF;;o:� dThru i
Bonde
-
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIE .
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.