HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR'APPLICATION TO BE ACCEPTED
Date: \y., \ \A Permit Number:
SCANNED, RECEIVED
rM r
St Lucie Coulaw JAN � 6 �018
Building Permit Applic tion
Planning and Development Services Bfi, L-ude County, Permltttng
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: ( a, r P
Address: u 5
Legal DescrQtion:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front
Back: Right Side:_ Left Side:^
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: 3a,0 Sq. Ft. of First Floor:
Cost of Construction: $ , ?500 Utilities: _Sewer _Septic
Name %1✓ T4AJ t'f `F-! Name:_
Address: 03 00 W4 P7&&0CV Company:
City: State: Address:_
Zip Code: L15 Fax: City:
Phone No. A _ 3 70` f` Zip Code:,
E-Mail: Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail_
from the Owner listed above) State or G
r Lice' nse
Lot No.
Block No.
Windows/Doors
_ Roof Pitch
Building Height:
Fax:
State:
If value of construction is 2500 or more, a RECORDED Notice of Comme
is required.
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SII.PPLEMEN ALL �}N�TR�CTI��l�i�lE�1#1AW IFVFORMAT{QN:��
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address: I
Address:
City: State:
City: State:
Zip: `Phone
I
Zip: Phone:
FEE SIMPLE'TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: I Address:
City: I City:
Zip: Phone: I Zip: Phone:
I
OWNER/ CONTRACTOR AFFIDVIT: Applicat;on 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 insAapction.. If you intend to obtain financing, consult with lender or an attorney before
commencing work oir recording o r Notice of Commencement.
Signature of ner/ Lessee/Contractor as Age t for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S-}%
COUNTY OF
The forgoing instrument was acknowledge before me
Ica
The forgoing instrument was acknowledged before me
this \4 day of YN , 20 by
this day of 20_ by
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary blic- 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 L-
Produced
�.y°�°°;`,• DEANNAMARIEGIVENS
�'6
Commission No. :' c l'�''s MYC((36,4SION#GG022023
Commission No. (Seal)
�9 :o EXPIRES: December 16, 2020
Bonded Thru Notary Public Underwriters
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DATE
nt_1
RECEIVED
DATE
COMPLETED
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ev. 712-014