HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: IP� I� Permit Number: 1ff
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Building Permit Application APR 0 6 1018
Planning and Development Services I Permitting Department
St. Lucie County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 I Commercial Residential
PERMIT APPLICATION FOR: To Select f�
PROPOSED IMPROVEMENT LOCATIO,
Address: i33C� M0,(rt>Y) `
Legal Description:"Gfbl UandI r
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Property Tax ID #:,3o �-i - en
Site Plan Name: Y A o, 1 eV
Project Name:
Setbacks Front Back: F
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ht Side
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Left Side:
DETAILED DESCRIPTION OF WORK:
11 �500 o 1 I --)n UP GO S -Fan)(--
der .+ �-�r-��r�c�l conne.CA-- .
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Additional work to be nertormed. under this permit - check
11HVAC Gas Tank Gas Piping
a
apply:
Shutters
Q Windows/Doors
Electric F]Plumbing
ElSprinkIlers
i
Generator
Roof Roof pitch
Total Sq. Ft of Construction:
I
S . Ft. of First Floor:
Cost of Construction: $ - l"1 "" { Utilities:
Sewer
Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
Name:
Address:
4
1 .::
Company.
City: '� �-. '� State: _
Zip Code: F �0 Vl•-�(Jlp-t
Phone No. ` 1 cQ6
Address:
1
City:
Zip Code•,
Phone No:,
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E-M il:
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Fill in ee simple Title.Holder on next page ( if diffe Wr
from the Owner listed above)
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State or County License:
WiG I�
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTR'UCTION'LI'EN' LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE, COMPANY: _ Not'Applicable
Name: I
Name:
Address:
Address:
City: State: I
City: State:
Zip: Phone I
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applilcable BONDING COMPANY: _Not Applicable
Name: Name:
Address: I Address:
City: I City:
Zip: Phone: I Zip: Phone:
I
OWNER/ CONTRACTOR AFFIDVIT: Application lis 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 OwnerslAssociation rules, bylaws or and covenants'that'may restrict or -prohibit such
structure. Please consult with your Home.Ow.ners•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 B l ilding 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 our Notice) of Commencement.
I(Z2
Lim (.MA�
ignature of Owner/ Lessee/Contractor as Agent for Owner ,
Signature of Contractor/License Holder
STATE OF FLORF�' 1 ' , /� , , p
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STATE OF FLORI
COUNTY OF C J--�/�C%1
COUNTY OF
T g instru ent wa acknowledgeto e me
T d y of 201
The ����,�,�'nstr entwas atknowledg fore me
this`? day of 20 f
V-,6 O
Name of pCarAn making statement I
ll�`
Nameoon making statement
Personally Known OR Produced Identification
Personally Known OR Produceq Identification
Type of Identification I I I/
`JO o[
Type of Identifi ti ,^ ,n
8 Q� OW
Produced [� `VI.tJ�
Produced
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Sign ture of Ida yo �� tr .Q rida)
Sign tu_ o !� cr u�j65, f Florida )
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Commission fa.>'� NQTARY N: =(Seal)
Commisgon�Vo. ®• Y N: _ (Seal)
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Rev. 8/2/17