HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLIABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r
Date: Permit Numb
I GGANNE
BYRECEIVED
AUG 10 2018
Building Permit Applicationittirl
Planning nd Development Services Department
Building ' d Code Regulation Division St. Lucie Ci,` ntyr FL
2300 Virg��ia Avenue, Fort Pierce FL 34982
Phone: (7,72) 462-1553 Fax: (772) 462-1578 Commercial. Residential
PERM III APPLICATION FOR:�>'✓
PRO.PSED INPROVEMENT d CATION:
Address:' pow
Legal Descrllption:
PropertyTa ID#:# ��� �-- —DOG) "boo Lot No.
Site Plan Na' e:. Block No.
Project Na
Setbacks ront Back: - Right Side: Left Side:
_Mechan
Electric
al Sq. Ft of
;t of Consti
to oe pertormea under tnis perms
Gas Tank Ga
_ Plumbing _ Sp
nstruction:.
:ion: $0, 0
e
- cnecK aii tnat.appiy: -
'iping _ Shutters
nklers _ Generator
Sq. Ft. of First Floor:
Utilities: / —Sewer —Septic
n c /e-A
Windows/Doors
_ Roof 2)_-,)'Pitch
Building Height:
QWN.ER E�S�SE:
C�(JNTR OR•
Name
Name:
Company:
Address:
address:
I
Clty: State: L
Zip Code: 4 9 51 Fax:
City: State:
I.
Phone No. D I
Zip Code: Fax:
E ]Mail: ii [a. Dom. ")
Fill in fee sim" a Title Holder on next page ( if different
Phone No
E-Mail
from the Ownlr listed above)
State or County License
If value of constroption is 2500 or more, a RECORDED Notice of Commencement is required.
SUP-P'L �NTAL C � � i` � 11CT10 G'E INFO
iM�►TI
DESIGNER/ENGINEER: _ Not Applicable
Name: �
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: 4111111111PState:
City: Stater
Zip: Phone 4110
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone: i
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 use's 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
commenci work or -recording our Notice
ncement.
Signa;ureiof0uiler,/ Lessee/Contractor as Agent fo
ner
Signature of Contractor/License Holder
a
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ��L�
a
COUNTY OF
The forgoing instrum t was acknowledged beforeg
The forgoing instrument was acknowledged before, me
this ) 19 day of 20 by
= °1,��,
this day of 20_ by
a
Name of person making statement.
Name of person making statement.
/
JRion
Personally Know OR Produced Identification
r�
Personally Known OR Produced Identifi
Type of Identification
Type of Identification
Produced jj. C
Produced
(Sign ure of Not Public- State of Flori ) 61
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
•I
I; MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
!-REVIEW
DATE
RECEIVED
d
DATE
COMPLETED
ev.