HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
RECEIVED
Building Permit Application
Planning and Development Services JUN 0 8 2018
Building and Code Regulation Division
ST. Luci Coun
2300 Virginia Avenue, Fort Pierce FL 34982 , Permitting
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line &(mil 0:r_ I
PROPOSED IMPROVEMENT LOCATION: ,
Address: %Q n Q-1�`� + L�u
Legal Description:',vex 4- r, i(lc - k f!O� 7 A'� 3� S �
Property Tax ID #: ��Il`7 Lot No. p_
Site Plan Name: Block No. O
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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u h p.; CAC �l�J ��2S (�.(cl S . 5 i i ill is vt -%US `
CONSTRUCTION INFORMATION: 5 p
Additional work to e e orme under this permit - c ec a apply:
1IHVAC F] Gas Tank ❑Gas Piping In _ Shutters Windows/Doors
0 Electric 0 Plumbing Sprinklers E Generator Roof la Roof pitch
Total Sq. Ft of Construction: o��-7
Cost of Construction: $ %�p 560 00
S Ft. of First Floor: _
Utilities:0Sewer El Septic
Building Height:
�o� I
OWNER/LESSEE: I CONTRACTOR: /
Name (_all'I05 i'i ► l U
Address: -7Q
City: 6 ') State:
Zip Code: ��LIQ Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:
Company:
Address::�56L(( SL-_- :S la+C('
City: thin +
Zip Code: 3C(7 Fax.%a
Phone No. -7-7,-:? l�
E-Mail:'
State or County
If value of construction is $2500 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 Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:_
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 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
commencingADrkfor recording your Notice of Commencement.
� n
Signat O ner/ Lessee/Contractor as Agent for Owner
Signature of Contracto /Lic s older
STATE OF FLORIDA',, �"
STATE OF FL 0Wrg�on
COUNTY OF NLU� V1
COUNTY OF
The for oing instrume t was acknowledge before me
this � day of l 20 �by
The fo going instru nt was acknowledged before me
this u day of 20Vby
Li V1 Q
Name of person making statement
Naphe of p rson aking statement
Personally Known OR Produced Identificatio
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced f (7�
Produced
(Signatu)of Notary Public- Stat FI ida)
(Signature INotary Public- State of lrridy
Commission No. h0w.R RESTIFO
Commission No. �V; Seal)
MY COMMISSION N 0091663
ExPutE3; May 17, 2021
of `j" , REBECCA RESTII+O
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETA 1 oPP`
MY CO
I 17'
0 GROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev. 8/2/17