HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED.FOR APPLICATION TO BE ACCEPTED"
Da te: t h • 1 -1 ' �� Permit Number:
Building Permit Applicati
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 . Commercial
PERMIT APPLICATION FOR:
Addlress: ') /
Legal Description:
Resit
C-1 S-z-
RECEIVED
n
',CT 18 2018
ST. Lucie County,,Permitting
lantial
S# Lucie County
Property Tax ID #: _� '[U L' b 1 U - U1 -1.1 --QUQ-1 Lot No.
Site! Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Additional work to be pprtormed under this permit - check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters /_ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator v Roof Z /2 Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 50D- 00 Utilities: —Sewer Septic ` Building Height.
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s 1+1 ��S'S'
Name .:� ESN' ��` 4
Name :. :._.: _ l.. ;
-
Address':` .eL, - /
Company;
City: '`-f State: (
Address:
Stater
Z�p Code:e-bZ Fax:
Phone No.
Zip Code: `ISM? Fax:
Phone No' ~?--)2
E-Mail:
Fill
in fee simple Title Holder on next page ( if different
E-Mail
from
the Owner listed above)
State or County License Cd (3at 1'7.0
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
R:' _ Not Applicable
Name:
Address:
City: State:
Zip: '�' Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:_
City:
Zip: 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 Coi hty' �niakes 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. P,l'ease 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing; work or recordine vour Notice of Commencement.
Signature of Owner/ Lessee/Contra ta_
s Agent for Owner
STATE OF FLORIDA
COUNTY OFF LUC ,,
The fo oing instr nt s acknowledg before me
this day of 20X by
Name of person ma <ing statement. kj
Personally Known OR Produced Identification V/
Type of Identiftntion
Produced L , h L_
n
ature of Notary ublic- State of Florida
Commission No. `t'��� — KARE(hegl)NIELSEN
�i4 ��;State of Florida -Notary Publi
'•®•= Commission fi GG 207484
of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF l-SJ
The fo ing instr nt hs acknowledge before me
this day of. 20 by
Pin � BMD (1) I(��
Name of person making statement. /
Personally Known OR Produced Identification
Type of Identific
Produced i
I�
(Signature of K ag�fgldtdik#a���'
ote y Publi
State of Florida•N
'O °= mission 0 GC� 207484
Commission '� •= Commission
IJune 201
REVIEWS, I COUNTER,``` REVIE REVIEW REVIEW REVIEW I REVIEW I REVIEW
ne PLANS VEGETATION SEATURTLE MANGROVE
DATE
RECEIVED
DATE
COMPLETED