HomeMy WebLinkAboutbuilding permit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q
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Date: Permit Number: 4
RECEIVE®
Builrig $ermit Applicatio i APR - 3 2018
Planning and Development Services
Building and Code Regulation Division Permitting; partment
2300 Virginia Avenue, Fort Pierce FL 3498
Phone: (772) 462-1553 Fax: (772) 461-1578 Commercial lRe%,ekygieX0unty, FL
PERMIT APPLICATION FOR: To,Select from dropbox, click arrow at the end of line
PRO_P�OSEDYIIVIPROVEMENT LO'C�i�►TION`
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Address:%444� —,,1 `OS e-64C C �-�-�i�. D( - q M ,�Q
Legal Description. l"1• -erve I V -e Lov 15 m(J�
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Property Tax ID #: 33�U— V 0 1 Q IXo` f I Lot No.
Site Plan Name: it__I (,I r)Q.. I Block No.
Project Name: U LL(✓OL-12
Setbacks Front Back: I Right Side: Left Side:
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DETAILED DESCRIP,TION O:FJWORK
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CQIVSTRUCTIQ,N INFORMATION'
itiona wor to e e orme under
E1HVAC Gas Tank
this pe - check
2Gas Piping
all
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apply:
Shutters
Windows/Doors
Electric 0 Plumbing
Sprinklers
Generator
Roof Roof pitch
Total Sq.1Ft of Constructiol1n::��
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First Floor:
Cost of Construction: $ "1`�'15�
I Utilities:cnSewer
Septic
Building Height:
0,1NNER/LESSEE
CONTRACTOR
Name
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Name: e
Company:
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City: 1" �f �`�: ,' State:
Zip Cod .:Fait: (.Q
Phone No. 0'-
City: 1�2 S22ta e.
Zip Code:3 Fax:
E-Mail: 1,n� /1 l I
Phone No.
E-Mail:
Fill in fee simple Title,Hoider,on ;next page( if di ern
State or ounty License:
from the Owner listed%above) : ;:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. I—, "%_3 1J.
LIEN LAW INFORMAI"ION.
DESIGNER/ENGINEER:
Name:
Not Applicable i
MORTGAGE COMPANY:
Name:
Address:
_Not Applicable
A'ddre5s:�
City:
Zip: Phone
State:
;
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name: �
Not Applicable
BONDING COMPANY:
Name:
Not Applicable
Address: �
City:
i
Address:
City:
Zip: Phone:
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i
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 thI'e 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 unl ergoing 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
commencingw rk or recordingour Notice of Commencement.
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Rev. 8/2/17 4FJ 171i1nu�����
SUPPLEMENTAL CONSTRUCTION
Signature Owner/ Lessee/Contractor as Agent for Owneri
Si nature of Contractor/License Holder
STATE OF FLORI�4
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STATE OF FL DA
COUNTY OF �- ��—�
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Name pe on making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of IdentIf. c io
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Type of Identification L
Produce �--� 1��O
(Sin e o Notary Publ c-State of Florida)
(Si not re of Notary Public- State of Florida )
Coro on No. (Seal)
Commission No. (Seal)
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