HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COlVirLcTED FOR APPLICATION TO BE ACCEPTE&
Date: I1'o Permit Number: I
I
RECEIVED
sUilding Permit Application r 2 3 2018
Planning and Development Services ST, Lucie County, Permitting
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:
Address: 260 r( Z- MAC .02i dIJIT of A�rAl`IN€�
Legal Description: BY
St Lucie County
Property Tax ID #: '
Site Plan Name:
,Project Name:
me:
Setbacks Front Back: _
Tota I Sq
Cost of I
Name
Addres
City: _
Zip Col
Phone
E-Mail:
Fill in f
from tl
Lot No.
Block No.
IN
Right Side: Left Side:
work to be pertormed under this permit = checK aii that apply:
anical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
ric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
of Construction:
struction: $ 40
130 LA
State:
33!?� Fax:
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
simple Title Holder on next page (if different
Owner listed above)
Name:
Building Height:
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.
f
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: I Phone Zip: Phone:
I
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name:1 Name:
Address: Address:
City: I City:
Zip: I Phone: Zip: Phone:
OWNERI 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,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessaryuses 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 ipsp on. If you intend to obtain financing; consult with lender or an attorney before
commenci work or rec din ou Notice of Commencement.
Signat ri of Owner/ Less a Co r o as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF l
COUNTY OF
The for inginstr fit acknowledge before me
s
The forgoing instrument was acknowledged before me
thisday of 20 [_ by
vny-)p icx 1 1(0 7
this day of . 20_ by
(Name of person acklnowledging) 0
(Name of person acknowledging)
(Signature of Notary Public-. fate of Florida)
i
(Signature of Notary Public -State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
pe of I Tydentific tqn
L Q L
Type of Identification
Produced
Produced
Commission No. KAREN $SEMI)ELSEN
Commission No. (Seal)
fate of Florida -Notary Public
•_ Commission # GG 207484
REVIEWS
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June 12, 2C
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22
OR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW .
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REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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