HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Slas 1 �� Permit Number: � 40 5 JdC00% a
RECEIVED
L f tuC a/county FRECEI
Building Permit Applicatio2 5 2018Planningand Development Services Building and Code Regulation Divisionunty, PePtiii€1 iP1Q
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential x
PERMIT APPLICATION FOR: GeneratoT EL
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
1 I�
J Property Tax ID #: r - ! l • - Q�_ Lot No.
Site Plan Name: .+I(&'� / Block No.
Project Name: I
Setbacks Front Back: Right Side: Left Side:
I DETAILED DESCRIPTION OF WORK: I
utw clelu(aru Wffn a0d
CxJif� S�-f�1Y1S'S Q (�R6 �i+�Y1 C,��1� �5} r ��(�CI�
►N�ul_eJ,
CONSTRUCTION INFORMATION:
itiona wor to e e orme under er this permit —check all apply:
11HVAC GasTank..<; Gas Piping In utters Windows/Doors
Electric ❑ Plumbing," OSprinklers RrGenerator Roof Roof pitch
Total Sq. Ft of Construction: ��--�� ^^ ���� S Ft. of First Floor:
t2iCost of Construction: $�`fl, d� Utilities:Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Addres :
Company:
. i-1k9ffAlu
City: State:
Address:
Zip Code. Fax:
City. IZQ State
Phone No.T
Zip Code: Fax:
E-Mail:
Phone No.
Fill in fee simple Title Holder on next page ( if different
E-Mail:
State or County License:
from the Owner listed above)
1
if value of construction is $Z500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone I
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address: I
Address:
City: I
City:
Zip: Phone:
Zip: Phone: I
' I
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 priori 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 Asso'ciatlon 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 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 your Notice of Commencement. _
Signature of Owner/ Lesl(ee/Contractor as Agent for Owner I Signature of
STATE OF FLORIDA
COUNTY OF Lv
The forgoing instrument was acknowledged before mel
this day of ► &4 20j? by
Name of person making statement
Personally Known �L— OR Produced Identification)
Type of Identification
Produced
Holder
STATE OF FLORIDA
COUNTY OF L-uctc
The forgoing instrument was acknowledged before me
this day of�� 20 by
Name of person making statement
Personally Known Y OR Produced Identification
Type of Identification
Produced
(Signature of
(Signature of N ary Public- State of Florida )
:F;
fVICIiOLE APattTE
�°�''•
NICHOLE APa tdTE
Commission N
=
MISSIdW� 179o3031
Commission No. ;�'�9•
ea
EXPIRES May 04, 2020
r;
'+� .. •;�
f.10I
MMISSI # F 963031
EXPIRES May 04, 2020
00i393-V•53
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Rev. 8/2/17