HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO 13E ACCEPTEa
it
Building Permit
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
PERMITTYPE: (7 �-
JAN 15 2019
ST. Lucie County, Permitting
Residential
m
1',PROP:OSEDr`INPR'OVEMENT LOCATION: - _ "`""""`Y
Address:- 'jAAOS li\KkY VCS ,�r�•`J�6�CC:(��FL_ 3yg5\
Property Tax ID #: - Q-JII01-�o OQ_- OOIo `dam 000-� Lot No.� \
Site Plan Name: Block No.
Project Name: ROOT:
CONSTRLIC-T N INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: A d" I Sq. Ft. of First Floor:
Cost of Construction: $ (I)-500 Utilities: —Sewer _Septic
Windows/Doors
_\ZR'oof Pitch
Building Height:
OWNER/,LESSEE "``
,..
CONTRACTOR.'`:
Name' a:�QS
Name:
Address:' O (lOR�1 -
Company:
City: p 1 State:
Zip Code: 3A41S\ Fax:
Phone No.--')') a -�%1\o�J -���3
Address:
City: 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.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
i
LIEN LAW INFORMATION:
Name:
Name:
Address:
Address:
City:
State:
City:
Zip: Phone
Zip: _
PANY: N
_2067 ill
FEE SIMPLE TITLE HOLDER: _ Not Applicable I BONDING COMPANY: _Not Applicable
Address:
City:
Zip: Phone:
Address:
Zip:
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
rnmmencine work or recordin"ouvlotice of Commencement.
Signature of Owner/ Les /Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA //II
STATE OF FLORIDA
COUNTY OF l,i.
COUNTY OF
The for oing instru ent was acknowledge me
this day 20 by
The forgoing instrument was acknowledged before me
this day of 20_ by
of
to
_
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificat on—
Type of Identification
Produced
Produced
(Signature of Notary Pub ic- 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
(�
ev.