HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI '
ALL APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� Permit Number: tidy-d11 4�
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V RECEIVED
Lucie County
Building Permit Application APR 3 0 2018
Planning and Development Services ST. Lucie County, PerrfllFfing
Building and Code Regulation Division --
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 I Commercial Residential_
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line1�e
PROPOSED IMPROVEMENT LOCATION:
Address: 1�"J2,�II �C�lD m(Jl+�� C��LSIn lr
Legal Description:t-t6k(-V"-,0(LrRl dne"
Property Tax ID #: 449CO Lot No.
Site Plan Name:-e�ref)+- Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION IF WORK:'
or- ►-o I 4 0d A"
v, c -er i- cinc� ,ro- -eali 4ro-n &r -er �- 01 1 �
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CONSTRUCTION INFORMATION:,
Additional work to b r orme un er t is permit-'',c ec a app y:
11HVAC Gas Tank Gas Piping I Shutters Windows/Doors
RPlumbing
Electric Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Construction: $ �`"[`'��� Utilities:nSewer Septic Building Height:
Cost of
OWNER/LESSEE:
CONTRACTOR: A;
Name '
Name: I
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Address: I t 2-Z LO IV 4+bn�.a(. h 1
Company:
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Address: S
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City: � State: ��
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Zip Cod �t`-�[ F x:
Phone N ��� �ii 61 l7 = .I l � __ • '
Zip Code: Fax r( �/
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Fill ir. gee simple Title Holder on next;page ('if different
State or County License:
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: Not4plicable
Name:. .
Address:
I
Address:
City:
Zip: Phone
State':
I
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
I
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 orand 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 oVrecQPding(your Notice of Commencement.
ignature of Own r/ L ssee/ ontractor as Agent for Owner
ignature of Contractor/ ' ense Holder
STATE OF FI.ORIDA l� �j .
STATE OF FLO!I I l
COUNTY OF
COUNTY OF C� 1 J�UL
The f r strum t ajn!ed)e efore me
by
The f r 'stru nt,�^� acl no ledged re me
this f 1 " t 20f
this a of
upic-i-V
Name of pe making statement'Name
of p making statement
n
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Pr odu
Produ ed
J1A
fA
(S' n re of Notary Public- State of Florida )
,Wig t of Notary Pub - State of Florida)
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COMPLETED .
Rev. 8/2/17