HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,T� 1, Permit Number:yq ► 6 -d S(3
.L 7RRECEIVED
Building Permit Applicatio 2 3 2018
Planning and Development Services
Building and Code Regulation Division ST. ounty, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential 6,---
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line 5�
PROPOSED IMPROVEMENT LOCATION:
Address: \s-il0�
Legal Description-%i en1-\'jrc. (3LA ya" 34R:,
Property Tax ID #: BY Lot No.
Site Plan Name: St Lucie County Block No.
Name:
cs Front Back: Right Side: Left Side:_
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to fgla
orme un er t is permit -c ec a app y:
V Tank Gas Piping _ Shutters Windows/Doors
Electric lumbing Sprinklers Generator Roof Roof pitch
—I
Total Sq. Ft of Construction:
Cost of Construction: $
S Ft. of First Floor: _
Utilities: oSewer Septic
Building Height:
;:OWNER/LESSEE:
CONTRACTOR:
Name
Address: `O D\
City: State'---
Zip Code: `3'�51.`�� Fax:
Name:
Company: SM ANN
Address:
City: L
Phone No. A Ck
E-Mail:
Zip Code: ���� Fax:
Phone No.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Nanie: Cc�
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address: C3v
City State:
Zip: one -
I
FEE SIMPLE TITLE HOLDER:
Nanj e•
Address:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
City:
City:
Zip: Phone:
I
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,
access) ry 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
co encing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contr or as Agent for Owner Signature of Con ractor/1.cense Holder
STATE OF FLU IDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument w s acknowledge before me The going instr ment was acknowledged before me
this day of X \� , 20_Vi by this day of 20 Qy
e-A ` S A- <� 1�-_
Name of person making statement Name of person making statement
Personally Known ✓OR Produced Identification Personally Known ✓OR Produced Identification
Type', of Identification Type of Identification
Produced Produced
(Sig ature of Notary Public -State of Florida) (Signature of Nota t _e gAF rida
�s�ar"�"��.;� STEL QQ M..1 UNTER
Commission NO. ,��������, STELL ENTER Commission No. 4 = Notary Pub�f�e��ate of Florida
_°. • �= Notary Public -State of Florida =• ` +'F Commission # FF 180552
=' : �0,•,2 Commission # FF 180552 �N.9FMY MY Comm. Expires Jan 23, 2019
iaZj
omm. xpires an 23, 2019 oug at REVIEWS r Nation l99PERVI OR PLANS VEGETATION SEA TUR E
COUNTER REVI R REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17