HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dati::,
Permit Number:
SCANNED
BY
RECEIVED
Applicatio
Planning and Development Services FEB 16 2018
Building and Code Regulation Division"
ci,z �0�9 tX' P r
ST. Luc'Q Count Per er fitting I
cPh' �_RTNTZL46 2-:1-55 3 Fax: (77 )462-1578 Commercial Residential
P I ERMIT APPLICATION FOR: To Select ffoM dropbox, click arrow at the end of line
Address:
Legal Description:
----------------
Property Tax ID
13D-
Lot No._
Site Plan Name: =, Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
ni
1 a Liv ug P iturmea unaer this permit — C ec a].�ap�
1HVAC Gas Tank Gas Piping
— Shutters
Plumbing RSprinklers
[:]Generator
Total Sq. Ft of
�Cost
Construction:
of Construction:
+ Utilitie
Sqj Ft. r Of First Floor:
[DSeptic
—]Sewer
Y ESS E7-
Name
Address-1 - ----------------------
Name:
City:
Company:
Zip Code- Fax: State: F1
Addr s:
Phone * •Ott
City.
E-Mail*
Zip Code:
Fill in fe6 simple Title Holder on next e it different
Phone No..SGI.Qe
from � the Owner listed above)
(-Mail:
1 1:
If value of construction is $2500 or more,
State or County License:
a RECORDED Notice Of Commencement
is required.
Fl-Windows/Doors
LJ Roof Roof pitch
Building Height.
" c
_a9kS__7
State:FL
Fax:Fax
1011 &_AW___(0J3L
SUPPLEMENTAL' CONSTRUCTION LIEN LAW INFORMATION°
�
DESIGNER ENGINEE Applicable
—� pplicable
Name: a
MORTGAGE COMPANY: _ Not Applicable
Name:
Addr s: �11
Address:
City: State:
Zip: Phone
City: State:
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 rior p to the issuance of a permit.
St. Lucie Counter 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
commenci work or recording our Notice of Commence—m
Si nature o Owner/ ssee/Contractor as Agent for Owner
`Signature o ` ontr or/License
STATE OF FL IDS
STATE OFF1
COUNTY OF
COUNTY OF
The forgoing instptVent was acknowledged before me
this 6— day
The f r ping instrumen was acknowledged before me
of M _, 20a by
thisday of .Q er 2014 by
Idkorri i em!3fc•(u
�_ t�Q�( 0-04,1. a, ii
Name of person aking statement
Personally Known OR Produced
Name of perso making statement
Identification
Type of Identification
Personally Known V OR Produced Identification
Type of Identification
Produced_.,,,,
Produced
(Signature o NO' '. �ItHm lG1410
=• ;'� MY COMMISSION # GG137624
(Signature of '
;=o;�"'°u PATRICIA ANN GRIFFIN
Commission Septen&Pd6, 2021
Commission N "'; ';
111"
MY COMMISSIONSM137624
EXPIRES September 26, 20'
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
SEA TURTLE
MANGROVE
DATE
REVIEW
REVIEW
REVIEW
RECEIVED
DATE
COMPLETED
Rev. 8/2/17