HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INF U T BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: ; Permit Number: 1401 - d,sd D q
%����J RECEIVED
DIV
Wild Application APR 9 2018
Planning and Development Services I ST. Lude CWMY) f)gf=MlUlnUj
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 j
Phone: (772) 462-1553 Fax: (772) 462-1578 1 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line���� { ��
PROPOSED IMPROVEMENT LOCATION;:
Address:
Legal Description: 1--0)te
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Property Tax ID #````�: Ywl ` OJ.S-C&�1 � - coo - i Lot No.
Site Plan Name::n)e-I Jrveb Block N�.
Project Name: ➢ 0\0_ i
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK(:'%"
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CONSTRUCTION, INFORMATION:
Additional work to e er orme under this permit - check a apply:
11HVAC 11 Gas Tank ' Gas Piping _ Shutters F-] Windows/Doors
41Electric Eli Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ � : �, Utilities:cn Sewer Septic Building Height:
"OW'N ER/LESSEE:
CONTRACTOR:
Name In
Imo(
Name: x
Address:
Company: 1
City: 1,0 State: `�
Code3 t� i Fa ��
Phone o:7-1-7 10
Address: A-
fL.�
PfLlZip
Zip Code: Fax: I lob `
o .17 LJ
E-M 'I:
Fill in a simple Title Holder
from the Owner listed above)
next page ( if different
E-Mail: 1004
Mal
State o ounty License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
,SUPPLEMENTAL CONSTRUCTIDN,LIE.N LAW INFORMATION-''
DESIGNER/ENGINEER: ' _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: I
Address:
City: State: I
Zip: Phone' I
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address: I
Address:
City: I
City:
Zip: Phone: I
I
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 grantinglla 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,'] 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 vour Notice of Commencement. d „
A L-1AW I
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' nature df Ow / L see/Contractor as Agent for Owner
Signature of 0 n9fact /License Holder
STATE OF FLOIl_,/, I�
STATE OF FLORID f I
COUNTY OF —� yl�i
COUNTY OF_ C
The ing instru e a knowleclefore me I
this day of 20by
Theo �stru t as cknowle efore me
this ad y of 2by
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Name of pa[yQn making statement
Name of person ma ing statement
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Personally Known OR Produced Identification
tFyod,QCed�� kntification
Personally Known OR P�_
Type of Identification
Type of Identificationwvec,, Gorrun iois ft GG
Produced
Produced
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(Sig atu of Notary Public- S ate Florida )
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW I
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17