HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONIAll APPLICABLE INFO, MUST BE
Date: 3 ✓15--
DR APPLICATION TO BE ACCEPTEu i �`(/` 2
Permit Number: 1 V V J— UqJ I
Planning and Development Services
Building and Code Regulation Division
2300.Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578.
PERMIT APPLICATION FOR: (V
Address:
Legal Description:
Property Tax ID #: ,a —
Site Plan Name:
Project Name:
Setbacks Front Back:
RECEIVED
a
MAR 15 2018
uilding Permit Application Permitting Department
St. Lucle County
Commercial Residential
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(Right Side: Left Side:
Lot No. a®
Block No. o .
Additional worK to be pertormed unaer tnis permit — cnecK an tnat appiy:
_Mechanical. _ Gas Tank _ Gas.Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof RIP- Pitch
Total Sq. Ft of Construction: Al Sq. Ft. of First Floor:
Cost of Construction: $ *ov 100 D Utilities: _ Sewer _ Septic Building Height:",
owAR/s�E :
con�Tae-o:
Name
Company:
Address:P�
`A',ddress:
City: C State#L_
Zip Code: Fax:
City: = State:
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Phone No. L V N
Zip_Codd: Fax:
E=Ma UM4n 3 G11�. Cd�(i1
Phorie Noy' i;
Fill in fee simple Title Holder on next page ( if different
Entail
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement its required.
SUP L&M MTJAlL CONS RUC'TIOI+J L` IEN LAW INF�R�MAi10
.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:,,
City: State:)
Address:
City: State:
Zip: Phone
I
Zip: Phone:
FEE SIMP„LE'TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City: I
City:
Zip: Phone:
Zip: Phone: I
I
OWNER/ CONTRACTOR AFFIDVIT: Application lis 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 oflCommencement 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 your Notice !of Commencement.
oyjjt it Loaf a `" -e /,Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
.�.
COUNTY OF _ ��� .�- I'-
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of CtzfGLj 201,� by
this day of 20_ by
(Name of person acknowledging)
V 9�z �, Jak
I
(Name of person acknowledging)
ti.
(Signature of Notary Public- Stat f Florida)
(Signature of Notary Public- State of Florida )
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Personally Known OR Produced Identification
X
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced Jl L
,�`"'»"%�
Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
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REVIEW
REVIEW
REVIEW
DATE
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RECEIVED
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DATE
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