HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE CO,.,.'�ETED FOR APPLICATION TO BE ACCEPT__
Date:
ST.
Building Ptn
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR:
Address: 5 GC
Legal Description:
Property Tax ID #: �')H I I ^y I.(
Site Plan Name:
Project Name:
Setbacks Front Back:
DEC 2 8 2018
q
Right Side: Left Side:
RECEIVED
DEC 2 7 2018
ST. Lucie County, Permitting
Residential
0 o w-_�
EONS CTIOf�FORMATIO
Additional work to beper orme l unriert his permit - check all that apply:
_Mechanical Gas Tank _ Gas Piping Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: 50 0 Sq. Ft. of First Floor: _
Cost of Construction: $ 1��� Utilities: —Sewer Septic
Lot No.
Block No.
1&1q( n„IV,
Windows/Doors
Roof _�� Pitch
Building Height:
C)WN£R:
GU TRTR O
Name Pl 0
Name:, -
/
Addr ss• O ; ".
Company:'
City:s o State:_
Zip Cod! e:1l7-2- Fax:
Phone No.7 2 Z (-U?iM 7
Address: '
City: "' ' T ' "'"" " State:_
Zip Code: Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder 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.
SUPP EMENU-'L Cs ST;
LIEN LA t
QR N:.
DESIGNER/ENGINEER:
Name:
_ Not Applicable i
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: —
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
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.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no repfesentation 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
commenci or recording o Notice of Commencement.
` � r
Signatur of Owner essee/Cq tractor Agent for Owner
/
Signature of Contractor/License Holder
STA OF FLORID
,STATE OF FLORIDA
CO NTY OF
COUNTY OF
The for ng in ment was acknowledge efore me -
this ay c) 20A by
The forgoing instrument was acknowledged before me
this of 20_ by
_day
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 jj L _
Produced
(Signature of No ary Public- State of Florida)
nature of Notary Public- State of Florida )
(Si2NOt�
Commission No. o"(,S al AREN S.ission
No. (Seal)
°�r'e Ste of FloridCommission
1
REVIEWS
FRONT
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VEGETATION
SEA TURTLE
MANGROVE
68i FIR15191I
COUNTER
REVIEW
REVIEW
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DATE
RECEIVED
DATE
P1 -I
COMPLETED
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