HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONs '.; .;.
ALL APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q
DaPermit Number:
MANNED
. st Lucie Go
Building Permit Application
Planning and Development Services JAN 3 0 2018
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 14(00
Legal Description:
PropertyTaxlD#: 1���-`�D1-Ua�3-c���3 Lot No. 8�
Site Plan Name: ,1 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
- Re_m cvi v � Poor -
CONSTRUCTION INFORMATION:
Additional work to be nerformed under this permit -check all apply:
�HVAC Gas Tank Gas Piping _ Shutters Q Windows/Doors
Electric El Plumbing Sprinklers Generator M Roof Roof pitch
Total Sq. Ft of Construction: ..,31DU 06 ¢7- S . Ft. of First Floor: oZ, (no 3
Cost of Construction: $ �,i V 00 Utilities:Sewer D Septic Building Height: = 6�
OWNER/LESSEE:
CONTRACTOR:
Name Q'`Efq �qo MSCE
Name:
Company:
Address: 4Co CAS SAcW l QG1b A-Vt.P-w -e
City: JQ2 ✓-� Pw-rc-StatefEi
Zip Code: _? 4 aL `HP Fax: % 7a (oS -a �73
Phone No.. 119- �5 ( 9 - 3 3 Z
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
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.
SUPPLEMENTAL CONSTRUCTION VEN LAW INFORMATION:
NER/ENGINEER: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:_
Address:
City:
Zip:
Phone:
State:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:_
Zip:
Pho
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
commencine work or recording vour Notice of Commencement.
Signature of 0 11r/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA `
STATE OF FLORIDA
COUNTY OF , ® . Lu C m e.
COUNTY OF
TheJ6 [going instr gent was acknowledg4 before me
The forgoing instrument was acknowledged before me
thisrJl day of 20'6 by
this day of 20_ by
'K_0MXa
Name o4erson making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
PRANCES R. DAMPIER
(Signature of Notary Pu c'S 1_FloAdtaroltsion # FF 959832
(Signature of Notary Public- State of Florida )
r My Comm. Expires'Feb 11. 2020
—1 `
Commission No.` QI Bono$(14ghNational Notary Assn.
ommission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIE
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17