HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPI-ti r l FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
SCANNED
t_ By - RECEIVED
S4 Lurie County
�' MAR 0 7 2018
w.. Amo µ �....._ Building Permit Application
Planning and Development Services ST. Lucie County, Permitting I
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 46271553 Fax: (772) 462-157 i Commercial Residential
PERMIT APPLICATION FOR:
lli®3�"7�i��T�il:(s77,®l sl�i i�T ei�TT►�
Address: �:)1
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
Additional worK to be pertormeci under
_Mechanical _ Gas Tank
Electric Plumbing .
Total Sq. Ft of Construction:
Cost of Construction: $ /Iy, cx'
Name7
Address:
City: /O
Zip Code: �J��i�% Fax:
Phone No._7'�
E-Mail: l ',/��,c%2'/1. . 53
Fill in fee simple Title Holder on next l
from the Owner listed above)
_I 1 ��( i
1
l I Right Side: Left Side:
( if
Lot No.
Block No.
mIt — checK all that apply:
Gas Piping _ Shutters _ Windows/Doors
Sprinklers — Generator, _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Name:
Company:
F-L Address:
City: State:
Zip Code: Fax:
Phone No
rent E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not App
Name: �..
Address: I
City: State:
Zip: Phone
FEE SIMPLE,TITLE, HOLDER:-, _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:-
Address:
City: State:
zip: Phone:
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 authorise 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 AssociIation 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 alNotice 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 Work or recordingryour Notice of Commencement.
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I
Sign a r of O er/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STA E OF FLORIDA
STATE OF FLORIDA
COUNTY OF �,,,��CI� ,
COUNTY OF
The forgoing instrument was cknowledge.4 before me
The forgoing instrument was acknowledged before me
this 1— day of 20by
this day of 20_ by
�.�
(Name of pers n acknowledging)
i
i
I � I
� L�L
(Name of person acknowledging )
(Signature of Notary Public- tate o lorida) I
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification t/
Personally Known OR Produced Identification
Type of Identification i
Type of Identification
Produced._ f� I— ,
Produced
Commission No.
Commission No. (Seal)
.aYP�B,!(,, KAREN S. NIFLSEN
e *; Commission # FF1 11 5637
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REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/ZU14