HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE IN
Date:
MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number -
SCANNED
�. AUG 17 2018
.. �, Building Permit Applic tion
Plannitllgand Development Services Permitting Department
BuildingIv and Code Regulation Division St. Lucie my FL
2300 rginia Avenue, Fort Pierce FL 34982
Phone (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR_`A:f' R;" r
�R1C1P 'ED "� IC3 ,Nr
Addres i S o L.I o a F`�� ° emaxi �
Legal D iscription:
Propertll Tax ID #: Lot No.
Site Pla Name- v Block No.
Project ame:
Setbac s Front Back: Right Sider Left Side:
Total Si
Cost of
N
al work to be pertormed under this permit -check all that apply:
chanical _ Gas Tank _ Gas Piping _ Shutters
ctric _ Plumbing _ Sprinklers _ Generator
Ft of Construction: 3 v Sq. Ft. of First Floor:
instruction: $ r Utilities: —Sewer —Septic
Windows/Doors
Roof Pitch
Building Height:
O�J1lN 3LESE=WAR
Name!
Address:
City:
Zip Ct"de:
Phon
D IJ l� r�ccJ�
Name: tV�� O
Company: -
ZI%l V JU E dCe13IJ 15L VO t
IIIIf� Ir.-i .State: _
3� �' Fax: -
No. L�� 7iZJ - 4 � L
Address: �� ® S S 7',
City: State:
Zip Code: ?j c,cl 0 Fax:
E-Mail(
Fill in
from i
Phone No -7-17-- 7. 4
I ee simple Title Holder on next page ( if different..
ie Owner listed above)
E-Mail e L SPL"- l<^
State or County License ot$C= 66,3 2
If value Of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: , _ Not Applicable,
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
City: Staterm.
Address:
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 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 record.ing your Notice of Commencement. -
�l OV�
utgiIen'tafdr'°Oiir'n"
Signature of Owner/ Lessee/C rta�
ig <ure,cafs ,ra or/License Holder
STATE OF FLORIDA,
COUNTY OF�5Z ZJ..Ie�-
STATE OF FLORIDA
COUNTY IF Chi j Loaf LS
The for oing instru ent was acknowledged before me
this i day f r-20
The forgoing instrument w s acknowledged before me
this "L d�y of 40by i
lame of person making statement.
ame of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Produced
r
Type of Identification
Produced.
(Signature of N aryublic- State of FIcTricla U
(Signature o otary Public -State of Florida
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLAN
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEWRE
REVIEW,
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
����1
ev.