HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COIVI ," rED FOR APPLICATION TO BE ACCEPTED
Date: I �. Permit Number:
RECEIVED
Building Permit Application OCT 16 2018
Planning and Development Services SCANNED ST. Lucie County, Permitting
Building -and Code Regulation Division BY
2300 Virginia Avenue, Fort Pierce FL 34982
Phon j: (772) 462-1553 Fax: (772) 462-1578 Commerd Lucie C®ul1�esidential i/
on
PERMIT APPLICATION FOR: ( 0
Legal Description:
Property' Tax ID #:
Site Plan Name:
Project ame: na
Setbacks Front B ck: _
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Right Side: Left Side:
_Mechanical _ Gas Tank _ Ga
Electric _ Plumbing _ Sp
Total Sq. Ft of Construction:
Cost of Construction: $ �'Y® 0
Fi1�'�<A�'.' M,
Fill in fee simple Vtle HoldeVon
from the Owner listed above)
VV".Y.
'ipirig _ Shutters
nklers Generator
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
next page (if different
Name:
Company_
alrl::�
u.
State or eunty Licen
Lot No.�
Block No.
Windows/Doors
Roof Pitch
Building Height:
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Not
Address:
City: I State:
Zip: I Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable.
Address:
City:
Zip: I Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
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 andcovenantsthat 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 1 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 accessoryuses 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
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Sign ur o- OwnVCLess a/ Contra cto as Ag nt for Owner
Signature of Contractor/License Holder
STA OF FLOA 1
STATE OF FLORIDA
. COUNNTY OF LS� , I�
COUNTY OF
The fr9C ing'instr en was acknowledg before me
201L by
The forgoing instrument was ack wledged before me
this day of 20_ by
thisday of .
(Namie of person cknowle ng)
(Name of person ackn ledging )
4�ifV�
(Signature of Notary Public -State of Florida)
(Signature of otary Public State of Florida )
/
Personally Known OR Produced Identification 1/
Personally nown OR Produced Identification
„��,,
Type of ldentififation KAREN S. NIELSE
Prod ced ;���` B'�. tate of Florida -Notary P
a of I entification
bl?� uc�
'* •= Commission # GG 2074
4
Commission No. %'�OFf (NMIFommission ExpiresC
mission No. (Seal)
fill" June 12, 2022
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Rev. 7%ZU14 v