HomeMy WebLinkAboutBUILDING PERMIT APPLICATION,
All APPLICABLE INFOJUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED .
Date: Permit Number: ��ld 115
Fn
CEIVED
2 2 2018
Building Permit Applicatiunty, PermIturm
Planing and Development Services
Building -and Code Regulation Division .
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Ld, { �+� 3�e I
Add
I Description:
6
Property Tax ID #: jr(/ S ® ,_-0176 ,O O0 —,7 St Wog.County
Site Plan Name: A Block No.
Proiect Name:
I
Setbacks Front k: Right Side: Left.Side:
nal work'
echanical
r this permit — check all that a
Gas Tank _ Gas Piping
Electric _ Plumbing _ Sprinklers
Shutters Windows/Doors
Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ D( n • Utilities: _ Sewer _ Septic Building Height:
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a
v
State:lZ
Zjp Code:. ZS Fax:
Phone No
EMail: Ab
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:
Company: -
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Not Applicable MORTGAGE COMPANY: _ Not Applicable
ame•
Name:
ddress%
Address:
tyA
State•
City: 'State:
p: Phone ►
,
Zip: Phone:
:E SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: _Not Applicable
ame:
Name:
ldress:
Address:
ty:
City:
p: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a. permit to do the work and installation as indicated.
I c i rtify 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 Commence t may result in your paying twice for
Improve is to your property. A Notice of Commencement m be recorded and posted on the jobsite
before a fl st inspection. If you intend to obtain financing; co sult h lender or an attorney before
coral ncl work or recordine vour Notice of Commenceme t.
na a of�0 ner. ssee/Contractor as Agent for Owner
ign ure of Contractor icense Holder
STATE OF FLORIDA
STATE OF FLORIDA
.'COUNTY OF
COUNTYOF
The forgoing"instrument was acknowledged before me
�JA
The forgoing instrument was acknowledged before me
this—J44, day of .d , 20A by
this day of . 20_ by
Lg
(Name
of person acknowledging)
(Name of person acknowledging )
(Signature
of Notary Pub - State of Florida)
(Signature of Notary Public- State of Florida )
Personally
Known OR Produced Id 6Gi3ii
Personally Known OR Produced Identification
Type
of Identificatio. DEANNAMAPJEGIVENS;
Type of Identification
Produced
". ISSION # GG 022023
..• .'�
Produced
'*• EXPIRES: December 16, 2020
.�'
Commission
'f� ea,aeaTtn(g PubGeUnd®rwrileB
No.
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLAN§
EGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW.
REYIEN
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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