HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPIITMD FOR APPLICATION TO BE ACCEPTED Date: Permit Number: / 6710- O "c -
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- RECEIVE®
Building Permit Applica ion JAN 2 5 2019
Planning and Development Services
Building and Code Regulation Division Permittin Department
2300 Virginia Avenue, Fort Pierce FL 34982 St . U CI U nt FL. -
Phone: (772) 462-1553 Fax: (772) 462-1578 -Commercial -Re - yr
PERMIT APPLICATION FOR: two Z)_ 8, T- d2"J 11r
Address: _/u
Legal Description:
7
Property Tax lD #: �� �� -S- 0 (0 7 �� d 5' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator X Roof Pitch
Total Sq. Ft of Construction: 160 C7 Sq. Ft. of First Floor: AtTE�-e7
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Cost of Construction: $ . �� g� Utilities: —Sewer _Septic -Building Height: Z
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OWNE /LESSEE:
G0 N TRACTOR:
Name 7l1
Name:
Address: 0 /QO ¢ C�2
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City: - t� %-9 IC126C7 State77i�
Zip Code:Ste_ Fax:
Phone No. ,� (�� 9!' (�
Address:
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City: L
Zip Code:
Phone No — � i_
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Fax:
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E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail ED
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State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL IrONSTk- GTION 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.
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 befo
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commencing work or recording your Notice of Commencement. <�• � ��z:
Signature of Owner/ Lessee/Contractor as Agent f
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Signature of Contractor/License Holder
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STATE OF FLORID
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STATE OF FLORID
COUNTY OF
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The forgoing instr nt was acknowledged before
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Name of person making statement.
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Name of person making statement.
Personally Known /R Produced Identification
Personally Kncwri OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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(Signature NotaryState Florida
(Signature of No Public- State of Florida)
of iblic- of )
Commission No. I(Seal)
Commission No. (Seal)
REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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