HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONqw
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `
Date: , Permit Number.:.
F®
x a �F -
Ot Lu I'e Clow RECEIVED
Building Permit Application MAR 06 2018
Planning and Development Services Permitting Department
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:
Address:j�
Legal Description: vcon ?�\ (— y '
Property Tax ID #: "" V U
Site Plan Name: T
Project Name:
Setbacks Front. Back: Right Side: Left Side: _1�..2, �`
187
e, 3S -31
Lot No.,06A
Block No.
_Mechanical _Gas Tank _Gas Piping i _Shutters )� Windows/Doors
Electric Plumbing _ Sprinklers _ Generator _ Roof Pitch
RtCK'r 1 e P 65 — 9Wf
Total Sq. Ft of Construction: A»� ,� 5jc�.�2 a1 Cp Sq. Ft. of First Floor: 4 1 1
Cost of Construction: $ C)oUtilities: _Sewer _Septic Building Height: '
Address: o M r
City: '� State:
Zip Code: 29Ici5�49 Fax: {��y
Phone No., _ — p 1— R9
E-Mail: mv) iigln@� AC11 (IrY'Yl
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
1-�C`om,pa'ny:,'
,Address: r :._`'
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
M1
If value of construction is 2500 or more, a RECORDED Notice of
is required.
DESIGNER/ENGINEER:
Name:
Address: .
City:
Zip:, Phi
!FEE-5IMPLEXITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
Applicable
State:
MORTGAGE COMPANY:
Name:
Address:
City:
Not Applicable
State:
Zip: Phone:
of Applicable BONDING COMPANY: Not Applicable
Name:
Address:
City:
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. AINotice 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 work or recording our Notice of Commencement.
i
i
I
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Signature caner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF,FLORIDA I
STATE OF FLORIDA
COUNTY OF C,UC ;e
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _(�_ day of M,p,�[i(n 20 by
this day of . 20_ by
(Name of p rson acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- Sta f Florida)
(Signature of Notary Public- State of Florida )
/
Personally Known OR Produced Identificationy
Personally Known OR Produced Identification
Type of Identification I
pe of Identification
Produced "YPUB�l, HEATHER BURFORD
to of Florida -Notary Public
oduced
'* * Commission # GG 18321
Commission No. "*mmission Expires
. mmission No. (Seal)
F9truary 06,.2022
REVIEWS
FRONT
I
ZONING
SUPERVISOR
PLANV
EGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVjA
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
kI27�
COMPLETED
Rev. 7/2014