HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONW
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
SCANNED
PMEIVE
Building Permit Application MAR 2 2 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from' dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCAI1O <;
Address: � fYl ,C (l�
41 Legal Description. - 21��`
Property Tax ID #: -600 -0 Lot No.
Site Plan Name: Block No.
Project Name: a ,
Setbacks Front Back: &Might Side: �_ Left Side: (�
CQNSTRUCTit7N INFORMATIONti ,
Additional work
to be performed under this permit- check
all
apply:
�HVAC
L__I
Gas Tank
Gas Piping
r",
Shutters
a Windows/Doors
Electric
❑
Plumbing
Sprinklers
❑
Generator
Roof
Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ ��._ i� . OCR Utilities:n Sewer Septic Building Height:
ODUNER/LES5,EE. E
_
CtaN7"RACTORV z
Name C�
Name: ie _
Addres : �i
Company:
7kk
City: State: _
Zip Code Fax:
Phone No._ -co) -I Im
Address:
UI
City:
Zip Code: '
Phone
Striate: F�
� _c & Fax: `860
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:'L
State or County License: LCy
4(00&4
a value o7 Construction is ac5uu or more, a KtLUKULU Notice oT commencement Is required.
A,
DESIGNER/ENGINEER:
Name:
_ Not Appli cable
Address:
City:
Zip: Phone
Stater
FEE SIMPLE TITLE HOLDER:
Name:
Address:
_ Not Applicable
City:
Zip: Phone:
I
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:.
BONDING COMPANY
Name:_
Address:
City:_
Zip:
Phone:
Not Applicable
Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is'Ihereby 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
imVeelt
ements to your property. A Notice of Commencement must be recorded and posted on the jobsite
be,e first inspection. If you intend to obtain financing, consult with lender or an attorney before
cocina work oArecordiniz vour Notice of Commencement.
d
atu ofaer/ Lessee/Contractor as Agent for Owner
Siature of C n ractor License Holder
STATE OFRV
" ,
i
STATE OF FLOR A� ,,
COUNTY OFN ICI i�Jl
COUNTY OFd�1JC+
The f°�rgoing instrument was acknowledged before me
1 20� by
The oC��ing instrument was acknowledged efore me
this��"'day of �� (U �1 2off by
tl day of
Name�of_pe sonmakmgsstatement
Name ofperso""" el ingstatement''
Persona iy Known ✓ OR Produced Identification
Personally KnownmOR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
ature o otar ADDAD
• `4Ff:...Q� •.
63 MY COMMIS OQN'� GG 009363
(Signature of Notary Public- S t Hrida) BEVL. HADDAD
;.: MY COMMISSION # GG 009
Commission No. (P P�5(SeaIpIRES:July6,2020
Co miss No. •: �'= 2020
° �J;•�t�t°`` Bid Thn� Notary Publk Untlerxni
EXpIRy�
ers �'�O� �'%;FddF ° �' Bonded Thru Noharyr Public Underwriters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17 U - - ` � v