HomeMy WebLinkAboutBUILDING PERMIT APPLICATION 4-13-18ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: oq '
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Building Permit Application Pers�t� °emu county
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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 Commercial Residential ✓
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal Description:
Property Tax ID #: 6 0 —0640 " 06 — f!
Site Plan Name:
Project Name:
Setbacks Front Back:., JQ/A,, Right Side: i
i DETAILED DEwSCRIPTION QW� WORK }
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LeftSide:
wee 416/1
Lot No. i 7 I
Block No.
CONSTRUCTION INFORNlATIQNAddr}
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itionaworkto a e orme��
under this permit- c ec
a
apply:
�HVAC
13
Gas Tank
Gas Piping
_
Shutters
Q Windows/Doors
11 Electric 0 Plumbing
Sprinklers
Generator
Roof Roof pitch
Total Sq. Ft of Construction:
S Ft. of First Floor:
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Cost Construction:$ 11
El
of 1G�
�(j() Utilities:.
Septic
Building Height:
01NNER/LESSEE,
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ame
Name:
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F.Y�`�
Address: 13312 N(tiJ (d)Do
PLACE
Company: _
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City: r% (i��
State: -
Address: I go
Zip Code: 3y'IqO Fax:
City: �,'F 40i
State:
Phone No. ??L—l n1- 5r1J1
Zip Code:
Fax- 3c
E-Mail:
Phone No.
Fill in fee simple Title Holder on next page ( if different
E-Mail:�
State or County License:, � 6 (,6)(o4
from the Owner listed above)
1 11 VC1 UU U! cu112Auucawn is acaoo or more, a rctwnutu Notice of commencement is required.
ASUP? IT 1L RUC, ',1O►K"L11EN I,4' 1�ifOR11lIATIO
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not 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
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
befor�i the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commncinR workor recordinR vour Notice of Commencement. _
A 16, J )U I / /e 6
re ?f0jmnei-/ Lessee/Contractor as Agent for Owner I Sgnature oyc�ntractor/License Holder
STATE OF FLO STATE OF`1FLORM%t4
COUNTY OFMd—L-10 COUNTY OF
The forg ing instru ent w s acknowledged before me
this day of 20J_k by
Name of perso making statement
Personally Known V OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State
;=o}'�Y'°B;E., BEVL.HADDI
Commission No� MYCOMMISSiON#C
o`= EXPIRES: July 6
Bonded Thru Notary Public l
REVIEWS I CFRONT
OUNTER I RONINGEVIEW S REVIEWOR
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
The forking instrt yeas acknowledged before me
this LLfday of C,tQJLc�� 20 ? by
Name of person making statement
Personally Known iOR Produced Identification
Type of Identification
Produced
ofNota{ryPublic-Stats
I�
BEVL.HADDAD
My COMMISSION # GG
nNo.,�al)pIRES:July6,2(
Bonded ThN Notary Public Urx
VEGETATION
SEA TURTLE
MANGROVE
REVIEW
REVIEW
REVIEW