HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
BY RECEIVED
St. Lucie County OCT 2 6 2017
Building Permit Application
Planning and Development Services St. Lucie CLucPERie C711dG
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Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FO
Address:
Legal Description:
S'Ina-I
Property Tax ID #: 'J- n - S 15 -61q(3 C y Lot No. i
Site Plan Name: M����[� Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side: }
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bETAIL€DeDESCRIPTION';OF°WORK, `; taw
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Auo1i1Und1 wuFK Lo oe errormeu unuerinis perma-cr
❑43ctr,
_ Gas Tank ❑Gas Piping
❑ Plumbing ❑Sprinklers
Total Sq. Ft of Construction::
Cost of Construction: $ Gob • c%-)
Shutters ❑ Windows/Doors
Generator Roof = Roof pitch
S Ft. of First Floor: _
Utilities:Sewer ❑Septic
Building Height:
OWNER%LESSEE:.'..,+�",`
CONTRA$C®R�
Name
Name:
Address: (
Company
City: Statef _
Zip Code: Fax:
Phone No.
Address: (35,a- V('
City: tesTV I' (CrOr _
Zip CodeSq jsi� i(
Phone No. �n l i�v-� w
Stater
Fax: -)1? 31 b p-o ��
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E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: Clr�(-Y ize �Yl�j(i
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State or County Lice esnunty Lice
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It value of construction is 52500 or more, a RECORDED Notice of commencement is required.
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DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 ain financing, consult with lender or an attorn efore
commencine work or recoctfiniz verur NotilffeAf Commencement- / /
Signature
as Agent for Owner
COUNTYOFORIIt 1 (�(, COUNTYOFORISTATE OF �����
The fo oing instWment was acknowledged before me
this cday of 1L) f— , 20-0 by
Name of person king statement
Personally Known OR Produced Identification
Type of Identification
The for oing instr�um�t yeas acknowledge efore me
this Zday osf M7 , 20��by
Name of perso aking statement
Personally Known =OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public-
Cj�'g ature of Notary Public -State of Florida)
e BARBARAW
#FF'1
`i6am
Commission No.
? tlS,pgIOMMIS�ION
fission No "� ""
I tip, BF(b�YARA WATSO
010 `'•;
EXPIRES August 28,
,.:
MY COMMISSION #FF7556
3980153
FlctlEaNOte SefvlcB.0
m 1....... 'P`i
,,?oF i�o�:.�� EXPIRES August 28; 201
(4
7) 398-0153 Floric
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Rev.8/2/17