HomeMy WebLinkAboutBUILDING PERMIT APPLICATION_4 r
ALL APPL1' LE INFO MUSTBECOMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� ^ a� �o SCANNED Permit Numb $ - [
BY
' St. Lucie County APR 2 0 2018
Building Permit Applicationi ST. Lucie County, Perm
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 Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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PROPOSED IMPROVEMENT LOCATION:'
Address: 6V
Legal Description:
Property Tax ID #: 09 4t / ,of -
Site Plan Name: �
Project Name: La 61y) �J
Setbacks Front Back:
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9Dzl -A�o-1:6 Lot No.
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Black No.
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Right Side: Left Side:
CONSTRUCTIONINFORMATION:
rtiona wor to e e orme under t-checkispermit a apply:
11HVAC UGasTank []Gas Piping In _Shutters ❑Windows/Doors
❑Electric ❑ Plumbing ❑Sprinklers ❑Generator ❑ Roof ❑ Roof pitch
Total Sq. Ft of Construction: SC • Ft of First Floor:
Cost of Construction: $ �. 80 D, 00 Utilities: L]Sewer El Septic Building Height:
OWNER/LESSEE- '
CONTRACTOR.
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Name
Name
Address:/0%Q.G fif Le
Company:
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V AaR�Lt/
City: Q Stater
Zip Code: Fax:
Phone No. '7 P - n2 �t q - 10 O119-oR
Address: /01
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City: , j�LP/Jf
Zip Code: °J
Phone No. '77,�
F� State:
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:
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State or County License:
c_-.2 /n 4A .5
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEWLAW INFORMATION:
Name:
City:
Zip:,
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable I MORTGAGE COMPANY:
F Address:
State: o� City: _
- qle' SA Zip:
V Not Applicable
Pho
Not Applicable
BONDING COMPANY: ✓ Not Applicable
Address:
City:
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, 1 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 vour Notice of Commencement.
Signature of 9"ney Lbssee/Contractor as Agent for Owner
Signature o oV4ctor/License Holder
STATE OF FLORIDA
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STATE OF FLORIDA //
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COUNTY OF
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Personally Known OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev.B/2/17