HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETE FOR APPLICATION TO BE ACCEPTED
Date' �` �ti, �� Permit Number:
' 111.1'c"`1�I RECEIVED
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' SEP 112018
Building Permit Appli ation
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division SCANNED
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial BY Residential_
CPIC
PERMIT APPLICATION FOR: !�
PRt�7POS:ED IN+PRaUfMlENT L(JC TIQN. a.
Address: ®(o a%
C,
Lakie
Legal Description: 4®' It/ r�'f�i,
Property Tax ID #: i�� - (�iLy`iJ `�l% `® Lot No.
Site Plan Name: eAdv Block No.
Project Name: _
Setbacks Front ® Back: Right Side: Left Side:
DET+AILED DE�SGRi�P ION C?F DR+IC:
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GO'NSl'R1JIT 11NFO' +IUTA ! • .
Additional work to be pertormed under this permit - check all that apply:
I �` "
_ Gas Tank —Gas Piping _ Shutters t�Vindows/Doors
—Mechanical
VEle',ctric mbing _ Sprinklers _ Generator b-"'Roof ��� L Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: 43JLl
Cost of Construction: $ ' Utilities: —Sewer _V<eptic Building Hei hht*,-,,
�" e
®UI/NERL�SSEE:
C t NTRA OR•
Name
Name: "�•• , . C
Address` <r
Company: - R
City: _ State.
Address: -
City:, Stater
Zip Code:
_
Phone Nlo. -
Zip Code:. _ 't ( - Fax:
E-Mail: I�. . ��
Phone No r a C +
Fill in feel simple Title Holder on next pa a (if different
E-Mail tU d
from the Owner listed above)
State or ounty Lic nse Ile�,�_/�iQf 1 i
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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�U"PPLEM�NTAL,C�T.+
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DESIGNER ENGINEER:
/
Not Applicable
_ PP
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City: State: !'
Zip: Phone
Zip: Phone: I i
I�
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.on.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] 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`i,n your,paying twice for
e improvements to your property. A Notice of Commncement 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 our Notice of Commencement.
Signature of O A er/ Lessee/Contra r as Agent for Owner
Signature of Contr ctor/Licens er
STATE OF FLORIDA
COUNTY OF 5-�_
STATE OF FLORIDA, ,
''COUNTY'OF
The forgoing instr ment was acknowledge before me _
Th6for`going instrument. was acknowledged before me
this � day ofp� 20 by
this � day of Sq pab 20L by
hiI,
.
� a {�► D c �} �► � �
Ct a c ti 0 c"v �► �,r1 �
Name of pe son making statement.
Name of person maki g statement.
Personally Known OR Produced Identification
Personally Known . OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced rr "k, ,
t
(Signature of Notary Pu lic- State of Florida)
(Signature of N - tat�� Ga?2o23
Commission No.'KA>r4 (Seal) '
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REVIEW
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REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17