HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONkPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Ao_2l
Permit Number:
.CANNED RECEIVED
BY
St, Ludo, AUG 2 4 2018
Building Permit Application
ning and Development Services ST. Lucie County, Permitting
ling and Code Regulation Division
Virginia Avenue, Fort Pierce FL 34982 /
ne: (772) 462-1553 Fax: (772) 462-1578 Commercial Residentialg/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Addr Iss:
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Site PlIan Name: Block No.
Project Name:
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CONSTRU FLON INFORMATION ��E
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it,ii na workto ejperformedun er't is permit -check apply:
❑HVAC LJ Gas Tank Gas Piping _ Shutters ❑ Windows/Doors
Electric Plumbing Sprinklers Generator ❑ Roof Roof pitch
71
Total Sq. Ft of Construction: ( S . Ft. of First Floor:
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Cost If Construction: $ S ` Z ( Utilities: Sewer L `�I Septic Building Height:
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Zip Code: G1��P Fax:
Phone No.
E-Mail: OCCUi 414a!2 S --,;
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ee simple Title Holder on next page ( if different
Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SURP1�EMENTAL
CONSTR,UCT[ON L1ENa LAIN INFf�RMATI,ON
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IGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Na
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e:
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Name:
Ad ress:
Address:
Cit State:
City: State:
is
Zip:Phone
Zip: Phone:
FEES SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Applicable
_
Na e:
_Not
Name:
Address:
Address:
City:
City:
Zip4l Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certIIfy that no work or installation has commenced prior to the issuance of a permit.
St. Lu `lie 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
struct`re. 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
rdance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
in ac111lowing
The f 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
comrIpencin work or recording our Notice of Commencement.
Signtiture
of 0 er/ Le'ssee/contra&&Ts Agent for Owner
SrrEeof Contractor/License Holder
STAT
OF FLORIDR�
SOF FLORID
COI
NTY OF �� I�� CJLf--
COUNTY OF a e,
The
orgoIng instrument was acknowledged before me
The forgoing instrument was ac nowledged before me
this
0day of Jilt kQ__ 20 kK by
this 2a day of 20 1& by
5 X U\1 Cc, d 2 r
Name of person making statement
I' Name of person aking statement
Personally
Known OR Produced Identification
Personally Known _� OR Produced Identification
Type
lof Identifi on
Type of Identification
Produced
6
Produced
Il
(Signat
a of Nota $-FIe+M
(Signature of Not' ry 1�,�1 ,., ta. a o rl �1 UTWILL
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+,,• '�, SUSAN L WALKER
' ission No. . Y C0MM�i��N #FF184083
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;:. Notary Public -State of Florida
Commission No. ' * * ° ommissio(AP4 032901
'+dFMA' EXPIRES December 16, 2018
N,o�Fa 11,oP�°;� ,My Com�tr.'Expires Sep 22, 2020
Bonded through National Notary Assn.
407 398.0153 FlorldeNote 9ervlce.corri
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Rev. 8/
/17