HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE I FO MUST BE COMPLETED FOR APPLI
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OLANNED
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Cor
TO BE ACCEPTED
Permit Number:ytd L) oa9�
RECEIVED
it Applicatio rl APR 11 2018
ST. Lucie County, Permitting
!rcial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line G„ s
PROPOSED IMPROVEMENT LOCATION:
Address: ' V
Legal Description:
Property Tax ID ,t�`1�OD'��—fit l ��— VlJ`t QU '-I'�JUti Lot No.
Site Plan Nam 'a. A� 1rayl
a �1� Block No.
Project Name:
Setbacks Front Back: Right Sidel: Left Side:
DETAILED DESCRIPTION OF WORK: ?
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CONSTRUCTION 'INFORMATION: 1'
Additional work to be nertormed under this permit— check all apply:
EIHVAC Gas Tank Gas Piping _ Shutters Q Windows/Doors
Electric FlPlumbing Sprinklers FI Generator F—I.Roof 1."-Roof pitch
Total Sq. Ft of Constr..uction: S nof First Floor:
Cost of Construction$ �v1`� Utilities:_Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Nam cmc)r
Addres /i
�J.% •
Name: l
Company:
�n
City: `i ��• 1--t��.%�—� •State:
Zip Code: CCity:
Phone No. v C
Address:
/� C State:
Zip Code: c_�Q I F x: R
Aorle No.
E-Mai : , MGLI
Fill i ee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
State o ounty License:
I
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SOPPLEMENTAL CONSTRUCTION. LIEN LAW INFORMATION:
DESIGNER/ENGINEER: -_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address: I
City: i State:
City: State:
Zip: Phone
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ IVot 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 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
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which is in conflict with any applicable Home Owners 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, fence's, 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.
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Signature of Owner/ Lessee/Contractor a i Agent for Owner
Signature of Contractor/License Holder
STATE OF FLQRT I �`�j-.�i
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STATE OF FLO!!!t
COUNTY OF a1 L�41- �'�
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COUNTY OF�L--J�iO��l
Li COUNTY
trume k c�wledge fore me
T51nom
The forgoi instrument was acknowledged before me
t�� 20y
i
th' da of 20_ by
f person making statement
of person m ement
Pn RR Produced
Identification
PeLYwn OR Produced Identification
T\�i& � C���ii��
9
Tyication
Produced N% \F..•
Produced
ri 9•
NOTARY
e®ISI�N••!p�f►O�.
(Signature oF-.Notarx PBfs V-Statgdf Flirida)
(Signature Nq rye 1j1 2t�,pf F%rida )
' d' �Mti1 GG�h���A �
Commission No'f� T' •.: �Vlo�r (Seal)
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= P U ®L�
Commission1lo.�. r (Seal)
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS.
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW .
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE.
COMPLETED
Rev. 8/2/17
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