HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONII
1
All APPLICABLE INFO MUST BE COMPLE'ic d'FOR APPLICATION TO BE ACCEPTED
Date \11 `i Permit Number:
SCANNED
By
FA
EIVED
St. Luce Cwty
17 2018
Building Permit ApplicPlannlpi g and DevelopmentServices unty, Permitting
Building and Code Regulation Division
2300 irginia Avenue, Fort Pierce FL 34982
11
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PER i' IT APPLICATION FOR:
Addres 1. .. 1-75 'k,_VQ
Legal Description: ���.� �J� � �%
Prope
Site PI
Projec
Tax ID#:
Name:
ame:
Front Back: Right Side: Left Side:
AM
Lot No.
Block No.
AdUitiolnal worK to be pertormea under tnis permit— cnecK aii tnat apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters /Windows/Doors
E ectric _ Plumbing _ Sprinklers _ Generator Roof `� 'Z�Pitch
Total S J Ft of Construction: a,� d d S� Sq. Ft. of First Floor:
Cost of'Construction: $ ]� , O d ® Utilities: _ Sewer _Septic Building Height:
4W
ER LE=N IE: M
CO' TRACTw
Namel']
Name:
Addresls:
Company:
,�a,��- '^ '�,�� Stated
city:
Address:`�.011
City: Statelc—_
Zip Code:
Fax:
Phone
E-Mail,i
No.
Zip Code: Fax:
Phone No —J -7 `2- ^— -- Z-7 72
.
Fill in �
a simple Title Holder on next page (if different, .
E-Mail <�LA
from the
Owner listed above)
State -or County License QC_z_ lS_z-
i
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
I R111 MORNST 1. C� ? STRIJ
4 L,I I.
F4 ION:
DESIGNER/ENGINEER: _
Not Applicable,
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
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.
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, l 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 your Notice of Commencement.
Signature of Ow --her/ Les ntractor Agent for Owner
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of . 20_ by .
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced
Commission No.
(Seal)
A. -A Ner A C:5r �_A��
Signature ontr ctor 'cense Holder .
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of 20_ by
(Name of person acknowledging )
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced
Commission No.
(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLAN
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVI
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014