HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr ..
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: O 4 Permit Number:
•MR
Building Permit Application
Planning and Development Services
Building; and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
RECEIVED
O U 2,3 2018
ST. Lucie County, Permitting
Commercial Residential 6/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line S�e
PROPOSED IMPROVEMENT LOCATION:
Address:
_►
Legal Description: S1��Ye_ —� %se 0— - C \ a65 1�� Fie,c�
SCANNED
Property Tax ID #: BY Lot No. 6
Site Plan Name: 'X St Lucie County Block No.
Project Name:
Setbacks Front ` Back: —Right Side: Left Side: X,0/A
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to e nertormed under this permit— check all apply:
0HVAC 0 Gas Tank ❑Gas Piping _ Shutters a windows/Doors
11 Electric El Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ �� Utilities: Sewer Septic Building Height:
,,OWNER/LESSEE:
CONTRACTOR:
Namesoy, h. IELA1,
Name: `-
Address:
Company:
City: ex gey-�_. � State:Y__
Address: Es .yS •��
y� d
Zip Code"J!-N�31 Fax:
City:
State
PhoneNo. `k%-J` rim
Zip Code: `a��l�o Fax:
Phone o.
E-Mail: l(\.—)CaC
Fill in fee simple Title Holder on next page ( if different
E-Mail:
from the'Owner listed above)
State or County License:
�o
If value of.construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: Mrz€� State:
City: State:
Zip: M,%ksna Phone
Zip: Phone:
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
bylaws
which is in conflict with any applicable Home Owners Association rules, 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 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 recording our Notice of Commencement.
zx
Signature of Owner/ Lessee/dohtradror as Agent for Owner
Signature of Co actor/License Holder
STATE OF FLORIDA
: "
STATE OF FLORIDA
COUNTY OF GW -�—
COUNTY OF ::-:* k,1, _X �Q__
The forgoing instrument w s acknowledged �b�efore me
this day of 20 1a by
The forgoing instrument was acknowledgeApefore me
this cV day of 20_�S by
Name of person making statement
Name of person making statement
Personally Known t-**'- OR Produced Identification
Personally Known C/OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida) .�
(Signature of Notary Public- State of Florida )
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Commission No. .�•`aaYP'••• STELLA M. HUN, rE
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t�ava��.,• STELLA M. HUN
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RECEIVED
DATE
COMPLETED
Rev. 8/2/17