HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONCa
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St Lucie County
Building Permit Application JAN 2 4 2018
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Commercial Residential
All APPUCABLE INFO MUST BE COMPLk-i.60 FOR APPLICATION TO BE ACCEPTED
Date: I ' c�T• % Permit Number: n V�
Planning'and.Development Services
Building and Code Regulation Division
2300'Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 . Fax: (772).462-1578
PERMIT APPLICATION FOR:
Address:
Description:
Site Plan Name:
Project Name:
Setbacks Front_ Back: _ Right Side: 7, Left Side:
_Mechanical _ Gas Tank _ Gas Piping
Y
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
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Block No. -, )
0 Yy? 1p17�1
CcfVI L
a
_Shutters _Windows/Doors
_ Generator Roof Pitch
Sq. Ft. of First Floor:
Cost of Construction: $ o? /Q 0 Utilities: _ Sewer-- _Septic Building Height:
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Name2-
Name- L
Addres :jk��e t "f✓'
Company: tcc
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City: S L"l/ Ll \-e" State: (-
Address:
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Zip Code: i Fax:
City: Ft /-e4c'e e.
State:
PhoneNo. ' %
Zip Code: 3 41! eP,'
Fax: %ice 4110to
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail I in f,4��
veeti G�
from the Owner listed above)
State or Cougy License
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ifvalue of construction is Z5oo or more, a RELUKUEU Nouce or wmmencemenz is requircu.
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
_
Address: 1
Svr11
Address:
City: G
State: P� L-e
City:
State:
Zip: Phone 'j
.. 7 S32- 500—
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
Address:
Address:
City:
City:
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 a first inspection. If you intend to obtain financing, co ps/ with lender or an attorney before
rnmi nFIna work or recnrdincy vour Notice of Commencement- i
nature of Owner/ Lessee/Contracto as Agent for
r=_
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDACOUNTYOF
COUNTYOFo
The forgoing instru nt was acknowledged before
4=
2 m
The for oing inst ent was acknowledge beforthis
day 20% by
H:�R
day of 20 by
� W
this of
(Name of person acknowledging)
N
(Name of person acknowledging) 'M
�N
N'
(Signature N Public- State Florida )
(Signature of Not ate of Florida)
of ary of
:%OR
Personally Known ProducedIdentification
Personally Known/ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Commission No. (Seal)
,Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
4EGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. //LU14