HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Building Permit Applicatioh JUN 19 2018
Planning and Development Services
Building and Code Regulation Division Permitting Dep rtment
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie Cgenty, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal Description: 6 2— '91 Y ` 7— L(�
Property Tax ID #: 1n�1 L -W4.� '"j Lot No.
Site Plan Name: "� Block No.
Project Name: ti`1a �1,���
Setbacks Front Back: Right Side: Left Side:
E1HVAC
❑ Electric
"Shutters
0 Plumbing Sprinklers 1:1 Generator F]Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
S Ft. of First Floor: _
Utilities:Sewer Septic
QWindows/Doors
Building Height:
Name
Name:
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Address: d
Company:EA�ke
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City: State:
Address:
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Zip Code: Fax:
City: VRW 6
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State:
Phone No. hm 1w,Zip
Co e: ILMR
Fax:
E-Mail: am
Phone No. 111M.
Fill in fee simple Title Holder on next page ( if different
E-Mail:
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from the Owner listed above)
State or Count
icense:
IT value or construction is W500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: St te: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: _ of 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 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.
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Signature of Owner/ Lessee/Contractor as Agent for Owner
Sign at of Contractor/License Holder
STATE OF FLORIDA
COUNTY OFF VylA
STATE OF FLORIDA
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i,rl
COUNTY OF
The fFQ9ing instrumentt was acknowledged before me
thisr'ljay of J Gl,bl� 20 by
The for ng instrume t was acknowledge efore me
this day of 20 by
SA
Nam of person aking statement
�OR
Nam of person/making statement
Personally Known Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
gnature of N ary Public- StatVVOQF o '
i t re o Notary Pub tate ofgiri '
a �►sa ° Notary Public State of
Commission No. hf�73 ,� I) Lacey L Rizzo
FI rida Notary Public State
�ommi ion No. I i0YJ7'J� Z e`�I) Lacey L Rizza
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My Commission GG 1
Y' Expires 1211712021
8732 '., - g My commission GG
"? Expires 12/17I2021
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17