HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLIC LE IN. ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:4;gq 1' Permit Number:
CAN
BY
ore � NOR-- - — St Lucie County RECEIVED
Building Permit Application APR 3 0 2018
Planning and Development Services
Building and Code Regulation Division ST. Lucie County; Perhiittin
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 LOCATI.ON
Address: i'J2�P lIV 4.1� ibLt
mp,ri b-,�S"1� l r01 ( NC,
Legal Descriptionfl&WLV dff,
Property Tax ID #:�� l- i't::I.JU 3 Lot No.
Site Plan Name: t1)1 ��4 C,f'
n � . � Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:.."
GONST,RUCTI;O'N IN.FO,RMATION:.
Additional work to be er orme un ert is —checkpermit a apply:
-HVAC N1Gas Tank ❑Gas Piping _ Shutters Windows/Doors
Electric ❑_ Plumbing Sprinklers ❑ Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
e
Cost of Construction: $ Utilities: _Sewer 11 Septic Building Height:
I
OWNER/LESSEE:
`CO•NTRACTO'R:
Name `e.n
Name:
ILA
Address: `J Sh fir•
Company:
City:
Zip Code:
Phone
State�L--'
0 Fa —
—10 ,
Address:
t
City:
Zip Code: ..
Phone to
Stater �--�
ax��
E-Ma
u i 11
Fill in ee simple Title Holder-bn'Qt ge i eren
from the Owner listed "above) " L: ,
E-Mail: • tea: L '
State or County License:
° ..
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Wt.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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
Name:
Address:
City:
Zip: Phone:
licable
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
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 permivwill 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 undergoinga fAl concurren y 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 an'd 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.
�?ZA AJ
Signature of Owner/ Lessee/Contractor as Agent for Owner Sign-ature of Contractor/License Holder
STATE OF FLORI Q( i , STATE OF FLORIZi
COUNTY OF VC L�VI I� COUNTY OF `` I--l/�
The go instru en was ackrickwled a efore me The f instru yen4ackned efore me
this ay of 20 b this ay of20 by
Name of pe on making statement ame ofNpgfson making statement
Personally Known OR P oduced Id ification Personally Know OR Produced Ide of on
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Type Prod f Iddentifica 'ors�►�d�l I Type of Id ifi at-}�O�r O
1 l Produced
SignatO a of Notary Public- State of Florida)
ure
of Notary Publit- State ofFTorida )
Commiss on No. (Seal)_
ssion No. '-(Seal)
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Rev.8/2/17