HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
L "eu, ERECEIVED
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Building Permit Applicatio MAR 19 Z018
Planning and Development Services Co P 'tt'
ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Legal Description:
Lot No.
Site Plan Name: Block No.
—Mechanical — Gas Tank Gas Piping —Shutters
Electric — Plumbing Sprinklers Generator
yna[_541W Qiio62 Sq. Ft. of First Floor:
Utilities: Sewer
C'. .0af, Septic
_ Windows/Doors
Roof Pitch
Building Height:
MN:LT
(Name
Address: _('0 36
1� 41
j f
city. 12,:b 19/ OC4- State:
,,Zip Code: Fax:
Phone,; No.-,,? 72 971 17 S'i-S
Name:*
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
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k V
E_ ' M, a il
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
E-Mail•
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
P L �1111E1� ' C � NST �.
CT � LI �N LAW I 'FORIUI
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _'Not Applicable
Name:
Name:
Address: , •.
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name: i
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 prior to the issuance of a permit.
St. Lucie County makes no representation thIat 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 i end to obtain financing, consult with lender or an attorney before
commenc4w work or recording; vddrl Notice,of Commencement.
Signature of Owner/ Lessee Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF .
�UG► J�,
COUNTY OF
I
The fo oing instrument way
this day of
acknowl edg efore me
20by
The forgoing instrument was acknowledged before me
this day of 20_ by
�V ' V1. I11 1104
l (lam
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of IiAary ubli -
State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identif* tion
Type of Identification
Produced
duced
KAREN S. NIELSE
Commission No.
o mission # FF 115G
(S0 Expire
7
C mission No. (Seal)
a ommission
June 12, 2018
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