HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ]
Date: Permit Number:��
SCANNED
Buildhig e�ef tkApplication
Planning and Development Services MAR 2 3 2018
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 dro,pbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: + _-�L
Legal Description: Cis ��,C�9 1� (\�_ ).li, )n lcQ bL, eg 7;N Jo V //
Property Tax ID #: ��, w; " Cu
Site Plan Name:
Project Name: N,)CLE1 E�
Setbacks Front Back:
FDETAILEP DESCRIPTION OF WORK:
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Right Side: Left Side:
;11JHe-
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Add itiona I work to be nprformed under this permit — check a apply:
1JHVAC Gas Tank ❑Gas Piping _ Shutters O Windows/Doors
Electric � Plumbing Sprinklers E Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
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Cost of Construction: $ i `� Utilities. —Sewer, —Septic Building Height:
OWNER/LESSEE:,
CONTRACTOR:
Name 1
Name:
t
Address: t��c�jM Phra��—IM'j(�r
Company:
c
City: State:
Address:
Zip Code:cit:c�
City: H State:
Phone No.
Zip Code: Fax:
E-Mail:g( rr1pl� 1 1 , CUM—
�n
Phone No. / 1
Fill in fee simple Title Holder on next page ( if different
E-Mail:
from the Owner listed above)
State or County License:
IIit value of construction is S2500 or more, a RECORDED Notice of Commencement is required. I
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIG R/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Addr
Address:
City: State:
City: State:
Zip Phone '-
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: l
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 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 doi 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 intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commenc en .
Signature of Owner/ Lessee/Contractor as Agent for Owner Si r7 ture of Contract r/ ' ense Holder
STATE OF FLORIDA_ , 1 �} �` f
OUNTTATE OY OF
f
COUNTY OF �JV YI'1 l
Th oin ins ru t w acknowled before me
th day 20 by
Name of person making statement
Personally Known OR Produced Identification
Type of Iden i 'cation
Produced J
(Signatu Notary Pu 'c- State of Florida )
Commission No. �I AIcl) (Seal)
H LLY BURGESS
REVIEfl'h'NTE-RmvrARfnVJfffif21141
*Rary P UIOMU6of F JdJ ERVISOR
VIEW
COMPLETED
Rev.8/2/17
The f c instr a wa ` knowled efore me
this day of 20� by
Name of persom making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(i nature & 'F FA ) 0
tary Public ate of Florida )
Commission No. UU(Seal)
BURGESS
SEAffldil+Tdi:®a MANGROVE
i #ZED/&E'U; 2 I REVIEW
Bonded through National Notary Assn,