HomeMy WebLinkAboutBUILDING PERMIT APPLICATONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: IQ- I k Permit Number: 1 U r O q
RECEIVED
Building Permit Application DEC 0 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) 462-1578Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line _ BY �II
Address:
Legal Description:
Property Tax ID #: I J in I ` 1 xyl - — I Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Block No.
r-X'eo-r exisAr rco� o-" re -place w Alt, lbrac4J
�ka,0 l t nch soZe coae -*�--► 1-1 Loris- 0.-f-6
}+ri bw: 1 k' e-el j, � c.IL Cod u-* ---I 11PO4 8 - k(,q
HVAC 14(GasTank
Electric 0 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 'K
W
Piping UShutters aWindows/Doors
nklers U Generator L�bof `� Roof pitch
S Ft. of First Floor: _
Utilities:n Sewer E]Septic
Building Height:
:OWNER%LTESSEE: -
CONTRAC�+TOR:
Name
Name:
Address:
Company:
city: ebuh C iYL7z State:i-M
Zip Code: H Q �q Fax:
Phone No.
Address: S
City: V fIIL �V)eO& State:
Zip Code: �-�1 (O cr�r- Fax:
Phone No. — L[7 —W kQ_1
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: `(1 (-I11-e irno 4, - sI a-1yot) cor—
c
State or County License: (A cc ()!E�
It value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
pp"",
SUPPLEMENTAL CONSTRUC^T10N LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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.
no
re.
e the permit holder to build the subject structure
or and covenants that may restrict or prohibit such
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
commencine work or recordine vour Notice of Commencement.
of Owner/
of Contractor/License Holder
STATE OF FLORI 11 STATE OF FLO�
COUNTY OFF. �� lCA <2-- COUNTY OF
The forning instcu ent wasacowledged before me
thi�s�dayof 1eC 20ffby
ing instru ent was acknowledge efore me
day of �by
Name of person making -statement Name of pe son m statement
Personally Known �: R Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-2pt_e9f_1Florida ) (Signature of Notary
Commission No.
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
9LvaIpublic State or Fbride
anda P Sanddrson
My COMM'sebn GO 2211255
Expires 04/2512022
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