HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL A PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date �i ( SC N EL) Permit Number: �$d1-d5ga
St. 1il-weG®unty
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Building Permit Application
Plann ng and Development Services J U L 2 3 2018
Buildi �g and Code Regulation Division
_ucie County, Permitting
2300 irginia Avenue, Fort Pierce FL 34982 _ _ .
Phon ii. (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PER ,SIT
APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PRO PQSED4lVIPROVEIVIENT
LOCATION:
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Legal Description:
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Prope yTaxID#: IZ2ZZ."600"00-0/"000 —7 Lot No.
Site Pla Name: —1 t Block No.
Project Name: 7 STa7iA(S67
Setbac 's Front Back: Right Side L Left Side:
DETAILED QESCRI ION. OF WORK:
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3ol�c3o n Io 5fli bulldinc On hbw cfincrlttl Au plumbing no eleC+Y'
CONSTRUCTION INFORMATION:,
Additi a wor toBe ner orme un er t is permit — c ec athatapp y:
OH AC Gas Tank Gas Piping _ Shutters ❑ Windows/Doors
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El li ctric ❑Plumbing ❑ Sprinklers E Generator Roof Roof pitch
Total Sq Ft of Construction: �I�0Sa S . Ft. of First FI or: GI a� - r
Cost of onstruction: $ �� .10 UtilitiestSewer 4Septic Building Height:
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°OWN �1R%LESSEE:
CONTRACTOR:
Name
Address'1
City:
Zip Cod
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E-Mail:
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Company: colVol) if ill I
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Zip Code: ?�1 I Fax: �— �� j
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State or County License: C� )i.CJ i �I®1j
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q simple Title Holder on next page ( if different
Owner listed above)
If value of,;construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL
CONSTRUCTION LIEN LAWINFORMATION: .. ,
DESI
Name:
Add
City:
Zip:
NER ENGINEE _ Not Applicable
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MORTGAGE COMPANY: _ Not Applicable
Name':
Address:
City: State:
Zip: Phone:
1ess: I1A ?1(falt &QQU
State: L_
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Name:
Addri'ess:
City:
Zip:
i,IMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
City:
I
II Phone:
II
Zip: Phone:
OWN R/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
certif that no work or installation has commenced prior to the issuance of a permit.
St. Luci I County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which i in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structu e. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In cons deration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in acco Ildance 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,
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
impro'' ements 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
commen-cing work or record-im-vour Notice of Commencement.
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of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STAAl" OF FLORIDA 1, 4 LV� C I STATE OF FLORIDA
COU ; TY OF U COUNTY OF Oracm I' OJ
The f 'r ing instrum nt wa acknowledg efore me
this I day of M 20M by
Name of person3naking st4ement
Perso�if
ally Known OR Produced Identification
Type
Identification
Produced
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Iim;o EXPIRES: Jury 6 2020
Public Undom iters
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RECEI
DATE
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The fqr 'day
instrument w s acknowledged before me
this 1 day of S 20 22 by
Name of perso making st',dtement
Personally Known OR Produced Identification
Type of Identification
Produced
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(Sign of Nota Public- State of Florida )
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FRONT I ZONING SUPERVISOR I PLANS I VEGETATION SEATURTLE I MANGROVE
COUNTER REVIEW REVIEW _,-�--REVIEW RE I REVIEW REVIEW