HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED p
Date: 1 �. S Yz Permit Number: O 0 I
��- RECEIVE®
Building Permit Appliliation DEC - 5'2018
Planning and Development Services Permitting Department
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie County, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: '2\`N\ , e1eC'fr-)W , l
Address: U \,DV)V T-�- IJ Z L V iTLT `blQ-�,X
PropertyTaxlD#:
Site Plan Name: \
Project Name:
Lot No. 116 4 1
Block No.
Additional work to be performed under this permit —check all that apply: JU Lucie County
_Mechanical _ Gas Tank _ Gas Piping _Shutters _ Windows/Doors
Electric _Plumbing _Sprinklers
Total Sq. Ft of Construction:
n �
Cost of Construction: $ �D
Generator Roof. Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE:
CO 4 RACfOR:
Name
Address: S t i,
City: A • DXr"9. Statell�---L
Zip Code:-b2) 0 Fax:
Phone N (c)Z 0,5
e:
Company:
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: 5 c7w\
Fill in fee ple Title Hol on next page (if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLE ENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: -
_ Not Applicable
iteQL"
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: 3 O
Address:
city: �O�a
Zip bacZ:16p Phone`1 >
State:
--(o9 -Vo !5
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: ._
Name:
Not Applicable
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.
1 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 our Notice of Commencement.
/ ;a. '=
3 -
Signature of Owner/ Lessee/Contractor as Agent fo "cryef;„,•'
Signature of Contractor/License Holder
STATE OF FLORIDA a mK
STATE OF FLORIDA
COUNTY OF $ :R8 o
COUNTY OF
The fogoing instrument was acknowledged before mo i
The forgoing instrument was acknowledged before me
this S day of f 20ir by
this day of 20_ by
Name of person making statement. a "'
Name of person making statement.
Personally Kriciwn OR Produced Identification
Personally Known OR Produced Identification
Type of Identifi tiori
Type of Identification
AotxProduced (/,
Produced
(Signature of Nota ublic- State of Florida
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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