HomeMy WebLinkAboutBUILDING PERMIT APPLICATION (2)ALL APPLICABLE INFO MUST BE
Date: _, ' `' `A
COMPLETED FOR APPLICATION TO BE ACCEPTED
SCANNED Permit Number: 1�0'
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St Lucie County TRECEIVIE-D
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Building Permit Application 2018
Planning and Development Services
Building and Code Regulation Division 57"' �'Nifjunty, Per fitting
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
�brj`�15T�'l IOPROPOSED I:AOMM
Address: 0,4 iery a s
e, � 3081.
Legal Description: C911S-re/vy'd LOT rts
Property Tax ID #: -3"5 -- 600- b 00a - 000 2� Lot No. I
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Site Plan Name. 2i Block No.
Project Name:
Setbacks Front Back: 9 Right Side: Left Side:
DETA,lLE'DA S.CRIP'f ION';OF WORK n
50 U tj N-0 L_ v
CpNSTRUCTION INFORMATION
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hUnnalworl(tobenertormed unclertnis permit- cneCK all apply:
aHVAC _ Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
❑ Electric ❑ Plumbing ❑Sprinklers ❑ Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: a 7 a I enJ S . Ft. of First Floor:
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Cost of Construction: $ Utilities: Sewer Sewer Building Height:
OWNER/LESSEE
CONTRACTOR
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Name OS S I t
Name:
bi✓iit;
D i i)01"5 i �—`
Address: " �-i5rel i
Company:
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City: �� State: f'L
Address: S z3 5YA+e1'V
Zip Code: 7J �, Fax: !
City: i e r e State:
Phone No. 2� 7
Zip Code: 3 _ - - Fax: - -
E-Mail:
Phone No. 7 7.;�, 8-0 /— 854 C n
Fill in fee simple Title Holder on next page ( if different
E-Mail: h,0C 015' Sand m `
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
.SUPPLEMENTAL CONSTRUCTIONLIEN LAW INFORM4TION
DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:�69 a IA5
Name:
Address:4'0a
L 19it a
Address:
City: 0 o m
State:
City: State:
zip:,Az Phone A5 77,9
Q5-41
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Zip: Phone:
FEE SIMPLE TITLEHOLDER:
Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
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 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 Flo iida 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 our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA � I
COUNTY OF �
COUNTYOF l� ULC
The forgoing instruXnent was acknowledged before me
this day of ��L 20 I S by
The forgoing instru pent was -acknowledged before me
this day of 20 by
W Q_ CQ Q1
Name of person making statement /
V
Name of pn making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification ��
Type of Identification
Produced
Produced
(Si ature of Notary Public- Sto of Florida)
(5 ature of Nota Public -Sae of Florida)
Commission No. I MMhom
Commission No. Irlgrahatn,
t. 1 LIC
NO'I�
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REVIEWS
FRONT
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46MERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
Sizl
RECEIVED
DATE
COMPLETED
Rev. 8/2/17