HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLI ABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I 53
SCANNED
BY
rl p �o
_ St I�uri�i�r° C6U RECEIVE
Building Permit Application JAN 2 51018
Planning and Development Services Permuting Depa�ment
Building and Code Regulation Division ` St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Generator
El
PROPOSED IMPROVEMENT
LOCATION `"'
.. ..
Address: III -Oki 0
Legal D
Property Tax ID #: 0(9 I — InI-
Site Plan Name: I end. )k
Project Name: TDW �1
-I 7
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION Or WORK;
aj I � ILO0ene-roa � a -+or v�1 OD
aLt),
CONSTRUCTION INFORMATION..
—AUditiona wor to e e orme under this permit- c ec a apply:
11HVAC Gas Tank ❑Gas Piping _ Shutters Windows/Doors
q
Electric 0 Plumbing ❑Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ J.p`' UtilitiesSewer Septic Building Height:
OWNER/LESSEE: CONTRACTO
Name Name: ILI�a�a
Address: Company: it ' ::�_e G
City: State F-Ll Address:
Zip Code: Fax - � City: Stater,,
Phone No IQ -+' • Zip Code: Fax Ices
E-Mail: 11. Phone No 0
Fill in fe simple Title Holder on n6& page ( if di -Mail: i
from the Owner listed above) State o ounty License: 3
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
U� ,
SUPPLEMENTAL CONSTRUCTION, LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _I Not Applicable MORTGAGE,COMPAr: _ Not Applicable
Name: I Name:
Address: Address:,,
City: State: City: �` State:
Zip: Phone 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 the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing wor or reco ing ' our Notice of Commencement.
i
Signature of w er/ essee/Contractor as Agent for Owner
Signature ofKon'fictopfmcense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20_ by
this day of 20_ by
Name of person 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
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17