HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONf
All APPLIICABLE INFO MUST BE
Date: 1 v 1 v�
,R APPLICATION TO BE ACCEPTED Permit Number: a,-
P,ECEIVE®
Building Permit Applicati n .SEP 1 $ 213
Plannin'g.and Development Services ST. Lucie County Permitting
euildi4 and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone -l(772) 462-1553. Fax: (772) 462-1578 Commercial Residential
[�ERMIIT APPLICATION FOR: 5 ,� m
Addressl '
Legal D ,scription: `
Propert*1Tax ID #:
Site Plat Name: _
Project (Name: —
Setbas Front
35 3 L� '
nz
Back: Right Side:
(/)n� l/ h,(i
Left Side:
Lot No._
Block No.
Additio ial work to be pertormed under tnis permit— cnecK aii tnat apply:
mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric = Plumbing -Sprinklers _ Generator _ Roof Pitch
Total Sq Ft of Construction: Sq. Ft. of First Floor:
I-T
Cost of Construction: $ tilities: —Sewer _Septic Building Height:
NameIIl V A--'l f/VL1 Ul I / LA-4,/ / . Name: V
AddreS's: Company:
�
City: State: Address:
i Zip C 'de: % Fa City: State:
—�
Phone No. � I Zip Code: Fax•2
E-Mail f — Phone No
I
Fill in ee situp a Tit a Holder on next page ( if different E-Mail
from t e Owner listed above) State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone
_ Not Applicable
State:
, IN
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
'City: Stater
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
.Address:
City:
Zip: Phone:
_.Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 job §ite
before the first inspection. If you intendto obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20_ by
this day of 20_ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
i
Personally Known OR Produced Identification I
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE,
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE.
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
"SUP{
LEMENTAL CONSTRUCTION" LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
N a m�:
Ad d ress:
_ Not Applicable
Dave a Laura Vam
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: 3725 Gordy Road
4456 Tamiami Trail, Unit B14
I Fort Pierce State: FL
City: State:
City:
Zip: 4398
Phone941"391-59so
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: —Not Applicable
Name:
Address:
Address:
City:1!
City:
Zip: Phone:
Zip: 11. Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certi �; that no work or installation has commenced prior to the issuance of a permit.
St. Luci 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 Idance 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 vour Notice of Commencement.
Signa ure of Owner/ Lessee/Contractor as Agent for Owner
STAVE OF FLORIDA S tu6e
COUNTY OF
The f"rg ing in
this V A%v c
me
Name of person making statement
Personally Known OR Produced Identification (/
Typelof identification -::j A /
of Notary Public- State of Florida
/ �4 ic)
i No. 1-7Z-°"r
FRONT I ZONING
COUNTER I REVIEW
DATE
RECdIVED
DATE
CO "PLET
Rev. 8 J2/17
i I
i it
Signature of Contractor/License Holder
STATE OF FLORIDA (ln r
COUNTY OF W lil
The f ing instir ny yi/ ,spa 5n ,q aged iefore me
this day f Jyj 1 2 by
alll (�Y�A/-(/
Name of person making statement
Personally Known OR Produced Identification's
Type of Identification �j 3
Produced G—
NICOLE L
Commission # F 9
My Commission Expires
Ao(l1 12, 2020
SUPERVISOR I PLANS
REVIEW REVIE)A
of Notary Public- State of Florida )
No. FF 6W 7Z
EGET,
REVII
N I I LA t`
Commi si n # FF £
AA sion E;
I II 2, 205
alssi n
I2, 2020