HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO UST BE Cd,':.R.ETED FOR APPLICATION TO BE ACCEPTL_ t�
Date: 2 �� PermitNumber: I I J
sus RECEIVED
Building Permit Application Nov 2 7 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 Cofi mercial Residential
PERMIT APPLICATION FOR: BY
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Address: O D 1 51-1 f r A P, 1P re 'e--
Legal Description: st4t vn S" �� 4S
Property Tax ID #: -1 2 I S "7 00 — 000 J1 _ d - U Lot No._�
Site Plan Name: Block No.
Project Name: sy1 o r CS 1 �vIC 1�
Setbacks Front Back: Right Side: Left Side:
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AcIclit ionalwomtooepertormeunderthis permit- c ec a tat apply:
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-Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
TotallSq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 21O /mod Utilities: —Sewer _Septic Building Height:
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OV1%NERLESSE `k
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CQ)fiRACfOR; �<
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Name:
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Address: Ia n 7 L -
Company: rr 'r n u
City: -F IcrQ' e. State: FL
Zip Code: Fax:
Address: 11 q3; L-uc,ip
City: �� Sf L,r e Te State: EL,
Phone No. 2'
Zip Code: -#3qq3'2— Fax:
L Phone No 2 3`70- 3U7
E-Mail:
Fill Lin fee simple Title Holder on next page ( if different
E-Mail at' ke-dY%Iv-Qd* b awlL
State or County License
fir the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER ENGINEER:
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Name: ��. c sr b(. r�i�iy
Address:
Not Applicable
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MORTGAGE COMPANY:
Name:
Not Applicable
Address:
City:
Zip: Phone Zz J
State*.—
3zl
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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
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
commencing work or recording vour Notice of Commencement.
Signature of Owner/.Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledgedbefore me
The forgoing instrument was acknowledged before me'_'.'.
this _ day of 20_ by
this _ day of 20_ by
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced'ldentification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
t I
DATE
COMPLETED
Rev.7/ZU14 q Q / /