HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `� ^
Date: I Permit Number:
_I' sue; RECEIVED
NOY
_ • - ., - - kAN%)
2 •0
2018
BuildingPermit AppPermitting
itting Department
Planning and Development Services ��, t. Lucie County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 St Lucie County
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: '�D rr
Legal Description:
Propedty Tax ID
Site Plan Name:
Project Name:
Setbacks Front Back:
I c: V-5kY-N ccC
Right Side: Left Side:
Lot No.
Block No.
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ham i �bac� CY-)(DN' \()CV34\ (nl. .er,c\p
L]HVAC IJ Gas Tank Gas Piping
0 Electric 0 Plumbing Sprinklers
Total Sq' Ft of Construction:
Cost of Construction: $
L _l Shutters
Generator
FWindows/Doors ' "
13 Roof Roof pitch
S�Ft.j of First Floor: - .
Utilities: L_ISewer Septic Building Height:
x - $ sec ,'...e.e�J.Is"'nT��•c_.;..i ifs ;+" ";3: 't
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Name
,Name' "..
Addressa > ('C�1 )<
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Company;
City: Stater .'
AiJdre'ss: .. _ .-- ,.:,• .. ..�.-,._
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Zip Code: q tS Fax:
City:
State:
Phone No. )i Q
Zip Code:
Fax:
E-Mail: 1 Ga010 .0
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the;Owner listed above)
State or County License:
If value oflconstruction is $2500 or more, a RECORDED Notice or commencement is requires.
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
-
Zip: Phone:
I .
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable I„
Name:
Name:
Address:
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,
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
rnmmanrina U/nek nr rarnrrlina vniir Nntirp of Cnmmenrempnt.
for Owner
Signature Contractor/License Holder
Signature wner/ Lessee/Contractor as Agent
.
of
J III
STATE.OF FLORIDA 011 /
STATE OF FLORIDA
COUNTY OF C� �Q��
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of �� inn 20 l by
The forgoing instrument was acknowledged before me
this _ day of 20_ by
ck
I
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
I
I
I
I
I,
(Signature of Notary Public- Stat
t'lg ggp,) E L L E N VA U
of Notary Public- State of Florida ) li
..
° e�v-State of Florida -No
Commission No.
al Commission # G
"sy o�. )
n No. (Seal)
:Expires].
My Commission October22
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW'
DATE
RECEIVED
a
DATE
COMPLETED
Rev. 8/2/17