HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONE
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `
Date: 3 �� SQAN�ED Permit Number:
_-- i P ( I IP�p. �� RECEIVED
Building Permit Application MAR 21 2018
Planning and Development Services 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: To Select from dropbox, click arrow at the end of line
PROPOSED`IMPR�VEME4T LOCATION. '
Address:
Legal Description:
CONSTRUCTION INFORMATION' ,
Additional work to beej orme under this permit —check a app y:
11HVAC L_J Gas Tank Gas Piping _ Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $� Utilitill s: _ Sewer Septic. Building Height:
OWNER%LESSEE
CONTRACTOR'.."4
Name `'1.
L
Address: : ' L-" =
Name:
Company: Un Al
'City: �°•e-: � Sate:
Zip Code:`. `� ` Fax: % '
Phone No. �cJ
j
Address:
' � " 1 O
ity:
Zip Code:
Phone No.
nr State I
Fax:�c�SIT iV�
E-Mail:
0 •
Fill in fee simple Title Holder on next page ( if ifferen
from the Owner listed above)
E-Mail:
Mai!
State ounty License:
If value of construction is $2500 or more, a RECORDED Notice of iCommencement is required.
41
DESIGN ER/ENG IN EER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: 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 cor6enced prior to the issuance of a permit.
St. Lucie County makes no representation t at is granting a permit will authorize the permit holder to build the subject stru6ture
which is in conflict with any applicable Homl� Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home 0 ners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requ�sted permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the lorida 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 Nlotice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you int�nd to obtain financing, consult with lender or an attorney before
Wmencing work or recording your Notice of Commencement.
Sign atdrde"of'bwn er/ Lessee/Contractor as
Agent tor Owner
Signature of Contra ctor/Licens-eRolder
STATE OF FLORIDS,
STATE OF FLORI
COUNTY OF
COUNTY OF -
*fore me
The forgoing instrument was acknowledged before me
?T(OJ�9' O-OLOG
7E�n (C-e c'-:6�0610 I
Name of p1X n making staterne
I nt
Name o%Kson making statement
Personally Known 1 OR Produced
Identification
Personally Knowrl" OR Produced Id t*f* tion
I mltin�(
ype o
go
uc
ProducemfgonaMA
A, AA
A
ps
No
En
REVIEW
REVIEW
REVIEW
EVIEW
DATE
RECEIVED
LO
FLOj�\v
COMPLETED