HomeMy WebLinkAboutBUILDING PERMIT APPLICATION•
•
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I Toq - O
LI
Date: 0 SCANNED Permit Number:
� RECEIVED
st Luc'ieconif
Building Permit Application APR 0 9 2018
Planning and DevelopmentServices
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 LOCATION:
Address:
Legal Description: Ntf-tUZ)
/)&7d ?nY/J•ir,4 - - w-1 A06
Property Tax ID #:
Site Plan Name:
Project Name: emwe u)(1
Setbacks Front Back:
Right Side: Left Side:
Lot No. 5?6
Block No. _
DETAILED DESCRIPTION
OF.WORK:
+ DY N'tCtr�tU L deLi l� — �61re. u54i
tN�I^ J, v "�
" Ccd G C��CIC« ✓►'l,e f"�- �Jn
CONSTRUCTION INFORMATION:
Additional work to e nertormed under tispermit-check all apply:
❑HVAC Gas Tank Gas Piping _ Shutters Q Windows/Doors
Electric E] PlumbingSprinklers Generator Yj Roof Roof pitch
Total Sq. Ft of Construction: ri S . Ft. of First Floor:
Cost of Construction: $ Utilities:Sewer[] Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name i eir
Name:
Company:
Address::5ni it
City: State:
Zip Code: Fax::
Phone No. Cig0 b-71 /6g�
Address:
City: f- State
Zip Code: 34WI Fax:-7-7a � 1 771?3
Phone No. 7Q 1
E-Mail: JagAgAQ-) czr_UrPJ
State or County I ense: C (fLEI�7L_ j
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
it value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
Address:
City:
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 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
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 your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contrac r/O older
STATE OF FLORID,A�//
COUNTY OF
STATE OF FLORIDA
in
/v(�
COUNTY OF 1U&#
The for oing instrum n wa's a knowledged before me
��
The forgoing instru nt as acknowledged before me
this,- day of 20Z by
this day of n 20�"by
✓� . ,U� r(1 c U
Leo UG ICcS o2
Nam of person making statement
NajAe of person making statement
Personally Known OR Produced Identification
Personally Known k OR Produced Identification
Type of Identifi io
Type of Identification
Produced
Produced
(Signatur of Notary Public- Sta of ri
(Signatur of Notary Public- St of lorida )
Commission No. I)
Commission No. q(�6' ' Y' �QA RESTIFO
'`"'REBECCA RESTIFO
- MMISSION # GG91863
7r"�
Y COMMISSION # GG91863oFRES:
May 17,202I°'
"ra9
Pa EXPIRES:
ay17,2REVIEW6,�erw�
I&W
O�1
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev.8/2/17