HomeMy WebLinkAboutBUILDING PERMIT APPLICATION�z
ALL APPLICABLE. INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (-P is SCANNED Permit Number:
BY
"Uji St Lucie County RECEIVED
a
Building Permit Application MAY o 12018
Planning and Development Services permltting Department
Building and Code Regulation Division St. Lucie County
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 LOCATION:
Address: GLpl�t3 E�n dQye_ Cli
Legal Description: �G QVe �+ ►%2 ITV e I_Q} - r-{—
2e�31Q- 15ic!
Property Tax ID #:—d-2O Lot No.
Site Plan Name: 1kX.(-(J i Block No.
Project Name:D
Setbacks Front Back: Right Side: Left Side:
DETAILED'DESCRIPTION OF:WORK t�
�py1 �lC-i-1 C'� —gyp
_4:TC"0) Conn �ec+-
CONSTRUCTION'INFORMATION:
Additional work to be nertormed un er t is permit - c ec a app y:
�HVAC _Gas Tank 14 Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing I prinklers ElGenerator Roof Roof pitcl-
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ Ci' Utilities:nSewer Septic Building Height:
OWNER/LESSEE,.
j ,
CONTRACTOR':
Name --ion
Name:
Q ' ••e1
Address: go) J --EnCJQUe,,: P)bO
C•e
Company:
City: 4-�c�� �- U-�Lll-'State: q:��
Zip Code: a x`_1 -7 �0 3(--UL037
Phone No. ��a�+D-!'��Q —('
Address: d� D�
ity: D%,�,( C j.State:
Zi ,Code: Fgx- 1
Brie AEo. -7�a> -4CDLo -IQQ6-
E-Mail: `iG'i Itv • aQ�-Q%acd2q a 1
Fill in fee simple Title Holder on next page ( i
from the Owner listed above)
different
E-Mail; 1-QnO 48C• 4i G COG`RM -C�i
State or County License: FL3if4Z
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
I
`'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 TIT.LE,IIO.LDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name: -o
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 Associationrules, 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
P `
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.
I alt 0 n u)ddl
Signature of Contractor/License Holder
Signature of Owner/ Lessee/Contractor as Agent for,Owner
STATE OF COUNTY OF ORI
STATE OF
COUNTY OF
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The f strume t a ck owled a efore me
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The fo en a knowledg d fore me
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Name o p son making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Iden • ic�t,�e,� � I j �
Type of ntification
Produced
Pr ced
(Sig ure of Notary Puf�a {�Fid�
(Sign ure of Not��%l�t -E�X� of Florida )
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Commission No.=>�'�°3o zp�iOSI
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Commission f�`��Ci���M�n���sp'� (Seal)
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DATE
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DATE'
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Rev. 8/2/17