HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETE
Date:
FOR APPLICATION TO BE ACCEPTED 77--
Permit Number: I. 0 V � --6q
SCAB NES
By ,
Lucie Count/
Building Permit Application
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:
Residential
RECEIVED
FEB 15 2018
Permitting Departm,
St. Lucie County
I: PROPOSELI'INPROVENtENT LOCATION.._ A . I
Address: c7C n/
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
2—
Right Side:
Left Side:
Lot No,
Block No.
Co'N5TRUCT[QN INFORMATION a ,
Additional worK to be pertormed under this permit — cnecK all, tnat apply:
::Mechanical _ Gas Tank _ Gas Piping Shutters _ Windows/Doors
_.Electric _ Plumbing _ Sprinklers, S.
_ Generator _ Roof Pitch
Total Sq, Ft of Construction: Scl.-Ft:.:of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE
CQNTRACTOR.`
Name '
Name:
Ad .
a
Company: rr el
Address: r✓ '� ��
City: ejz„e A'71' State:
Zip Code: ��/Fax:
City: State:
Phone No. `�0�,/ `�%/
Zip Code: Fax:
E-Mail:
Phone No
Fill in fe sirnjf(le Title Holder on next page ( if different
JI
E-Mail IF
from the Owner listed above)
State or Courilty License
r--
If value of construction is 2500 or more. a RECORDED Notice of Commencement is reauired.
j
SUPPLEMENTAL CONSTR
CTtt)N i:IEN
LAW IIVFORNIATIQN
a
DESIGNER/ENGINEER: _ Not Ap plicab,le _MORTGAGE
COMPANY: Not Applicable
Name: i
Name':'
Address:
Address:
City: State:
City: State:
Phone i
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: Application isihereby 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 her 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
e the first inspection. If you intend to obtain financing, consu ith lender or an attorney before
co me rinor work or recording our Notice of Commenceme ; -
Oki
Signa ure of Owne a/Contractor as Agent fo'r Si tur of Contractor/License Holder
STATE OF FLORIDA b STATE OF FLORIDA:'__
COUNTY OF LU COUNTY OF LS e—
•a.,,,,,,.,.
The forgoing instru ent was acknowledged before � The forgoing instrument was acknowledged before
this 1'S day of U (O �20J'J- by _o o this 1'5 day of. f-'�rL�Vk gd , 20 l Y by
Z SOS �m�S
-'[
LJ ft L 0,-,- S l C. CJ IA-:s 4- te `Jl�ir
(Name of person acknowledging) (Name of per on acknowledgingadA
U�y
IF -.11 v.l
(Signature o tary Public- State of FI rida) I (Signature of N a Pu ic- Stati of Flo da )
Personally Known OR Produced Identification _ C Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced_ L' j Produced �--
I
Commission No. (Seal) i Commission No. (Seal)
REVIEWS
FRONT
I
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
I
RECEIVED
j
DATE
COMPLETED
Rev. -_17