HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAli APPLICABLE INFO UST BE COMPLE7 OR APPLICATIO TO B @Yicka„ 1
-Date: ' �� 1 � Permit Number:
�► �`�'�9�` 2 2018
Building Permit AFAPR
at�On9ycle oun , Pegmitting
Planning and Development Services
Building and Code Regulation Division i
2300 Virginia Avenue, Fort Pierce FL 34982 -
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
Resident al
PERMIT APP LICATION FOR: S �_ R I
f
Address:
Legal Description:
Property Tax ID:
Site Plan Name:
Project Name: LCG (—I)EWP KC1,Yl re -I
Setbacks Front�Back:
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09
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Side: _(21.9left Side: 'i&'IC
Aaaitional worK to De perrormea - unaer tnis permit — cnec
`Mechanical _ Gas Tank _ Gas Piping
V Electric ✓Plumbing _ Sprinklers
Total Sq. Ft of Construction: -d; 5g`��I
all that apply:
_ Shutters
_ Generator
Sq. Ft. of First Floor: —
Lot No. o�
Block No.
Windows/Doors
V Roof
Cost of Construction:$ Utilities: _Sewer _Septic Building Height:
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WyIilLli/
bState[EILL
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Phone No. 6
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Fill in fee simple Title Holder on next page (if different
from Owner listed above)•�
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If value of construction is 2500 or more, a RECORDED Notice of Comgfencement is required.
SUfXPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN R/E&INEER
n:f r
_ Not Applicable
MORTGAGE COMPANY: Not Applicable`
Name:�Uel'
Name:
Address:
Address: Q
City:
U 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
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recordingyour Notice of Commencement.
S-rgnatN of L e Cont ctor as gent for Owner
Signature of Contractor/License Holder
STATE OF FLO D,
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The for oing instrum nt wasacl nowledg efore me
The forgoing instrument was acknowledged before me
this day of 20_ by
this Lay of 20by
,
Name of petp,1naking statement
Name of person making statement
PersonaAy Known OR Produced Identification
Personally Known OR Produced Identification
Type o Ilentifi ion
Type of Identification
rodu a
Produced
ignature of Notary Pu ' - Stat
ignature of Notary Public- State of Florida )
77�� ICOLE ELLENSON
041%'r'PUB(i
Commission No. V =1 6b9�OMMISSION #GG0891114C
ommission No. (Seal)
�r� EXPIRES: APR 02, 2021
""✓ Bonded through 1st State Insura
oB
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17