HomeMy WebLinkAboutBUILDING PERMIT APPLICATION.4�1. XPPLICABLE INFO MUST BE COI, , 01ETED FOR APPLICATION TO BE ACCEPTEv
Date: Permit Number: ����
T- �U RECezvED
bog ermit Application JUN 12 2018
Planning and Development Services errnitting pe
Building and Code Regulation Division St Cuc1e county ent
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 'IMPRO.VEMENT_LOCATION
Address:
Legal Description: 0
Property Tax ID#:I _6 I`" 0 f —_V��C
Site Plan Name: i 1 n,
Project Name: W
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF'.UVORK
Lot No.
Block No.
[,CONSTRUCTION INFORMATION:
itioria workto e e orme under tispermit-checka [nappy:
_JHVAC9plumbing
Gas Tank' [:]Gas Piping _ Shutters a Windows/Doors
13 Electric OSprinklers F Generator 0— Roof Roof pitch
Total Sq. Ft of Construction: S� of First Floor:
Cost of Construction: $ IA43 6 Utilities: Sewer Eheptic Building Height:
QWNER/LES'S.EE,
CONTRA TOR:
Name
Name:
Addr s:
Company: )
City: State:
Address:
Zip Code6a': j•I Fax:
Phone No. '� `l —0\I Lo Sao &a
Cit ' St e•
Zip Co e: j Fax: �4
E-Mail:
Phone No.
E-Mail: o
Fill in fee simple Title Holder on next page (if different
State or County I icense:
from the Owner listed above)
it value of construction is W500 or more, a RECORDED Notice of Commencement is required.
"UP EMENTAL CONSTRU
ON LIEN`LAW$INF.ORiMgTtON a.
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
BONDING COMPANY: _Not
Applicable
Name:
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 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 Bui (ding 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
commencine work or recording vour Notice of Commencement.
i
Signature of Ow er/ essee/Co
or as Agent for; Owner
Signature of Contractor/License H er
STATE OF FLOR-IDA►
STATE OF FLORID
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COUNTY OFy
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COUNTY OF
The forgoing instrument was acknowledged efore me
1 I �i
The forgoing ins ent was acknowledge before me
� day 20, by
this day ofii
, 20 by
this of
Name of perso making statement
Name of person making statement
z � o .e
Personally Known OR Produced Identification
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Personally Known _, Q OR Produced Identific its -_ — 9
Type of Identification
Type of Identification
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Produced
Produced
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(Signature Nota
(Signature otary Public- State of rida)
G ' r
KARLEY MARIE GIESY•VARNEY
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Commission No. : �°• •^;
NotaryPublifg of Florida
Commission No. (Seal)
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Commission S GG 099801
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My Comm. Expires May 1, 2021
Bcrdedthrough National Notary Assh.
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tev. 8/2/17