HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr`
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dat I: 16 81CANNED Permit Number:
BY RECEIVED
M. Lucie County
Building Permit Application JUL 1.6 2018
Permitting Department
Plan ing and Development Services St, Lucie County
Build"ng and Code Regulation Division
23;�'Virginia Avenue, Fort Pierce FL 34982
Pho ,e: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERk
APPLICATION FOR: To Select from dropbox, click arrow at the end of line
P.,RO;OSED
IMPROVEMENT LOCATIO
Lot No. I D
Block No. e3
AC _ Gas Tank Gas PipingM-FV. Y
_ Shutters Windows/Doors
ectric 0 Plumbing E]Sprinkleils" 1:1 Generator Roof Roof pitch
Total S Ft of Construction: 5 . Ft. of First Floor:
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'" Cost of I onstruction: $ n fir) Utilities: _ Sewer F—] Septic Building Height:
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Name
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City:
Zip Code:
Phone
E-Mail:
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simple Title Holder on next page ( if different
Owner listed above)
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State or County License: !�nZ i�nw6t)
IT Value or Construction is tiLSUU or more, a RECURDEU Notice of Commencement is required.
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Pt MENTAL CONSTRUCTION: LIEN 'WINFORMATCON a k
DESIGNMR/ENGINEER: Not Applicable
MORTGAG C PANY: Not Applicable
Nar e'I1
Name:
Ad e cx�
Address:Cit
is State.. L
City: State:
Zip Phone
Zip: Phone:
FE
SI E T TLE H LD R: Not Applicable
BONDING O ANY: Not Applicable
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Name:
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Address:
Cit '
City:
Phone:
Zip: Phone:
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OW 'ER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certi 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 's in with Home Owners Association rules, bylaws that may restrict
conflict any applicable or and covenants or prohibit such
struct 're. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In con ideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in acc 'Irdance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The fo slowing building permit applications are exempt from undergoing a full concurrency review: room additions,
access ry structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WAR ING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
impr wements to your property. A Notice of Commencement must be recorded and posted on the jobsite
befor' the first inspection. If you intend to obtain financing, consult with lender or an attorney before
co . ncin work or recording our Notice of Commencement--)
_
_5!gnat6re
of Owner/ 4essee ontractor as Agent for Own -
igrtatu re of Contr ctor License Holder
STA
E OF FLORID
STATE OF FLORIDA
COU
TY OF
COUNTY OFF-
The f
r oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this
day of 201�by
this -lb day of 20_aby
i,
�rw mo,/- iJ' S
Na a of person making statement
Name person making statement
Perso'
ally Known OR Produced Identification
Personally Known OR Produced Identification1
Type
�f Identification
Type of Identification
Produced
Lam-
Produced_
r
(Signa
ure of Notary Publ' tate of Florida)
ignature cf Notary Public- St f Florida )
Comm
ssion No. (Seal) 2 �a a
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ommission No. (Seal)
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VEGETATION
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REVIEW
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DATE
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DATE
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Rev. 8/2
,17 �= _
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