HomeMy WebLinkAboutBUILDING PERMIT APPLICATION�
ALL APRDCABLUNFO MLIST BE COMPLETED FOR APPUCAT|ONTQ8EACCEPTED
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Date: �SCANNEDPermit Numbec D ��'
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BY
St. Lucie C»Unh/
REC.2--EVED
Planning and Development Services
Building and Code Regulation Division DEC 112017
2300Virginia Avenue, Fort Pierce FlJ498Z
Phone: (77Z)45I'155JFax: (77I)46Z'l578 [ODODD8[Ci3l R9SideDti8l^_________
PERMIT APPLICATION FOR: TOSelect from drVpb0X`click arrow Gtthe end 0f line
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: __________ Right Side: Left Side:
^________
HVAC | [��| |GasTankE]GasPiping Shutters Windows/Doors
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L=JE|ecLric El []Sprinklers | [� |Generator | |Roof Roof pitch
Total Sq. FtofConstruction: S Fit of
Cost nfConstruction: $ ti|ides�| |Sevver[.1Jeptic Building Height:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: __4
State or County LicensA:
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if vaiue oi consirucxion is $zbuu or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW, INFORMATION:
DESIGNER/ENGINEER:
Name: 4i-14fG-S �-�I
_ Not Applicable
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MORTGAGE COMPANY:
Name:
�_ Not Applicable
Address:_f SF-
Address:
City: —
Zip:3 LtggL Phone
State: _CL-L�
_ -Z622ta
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
t,::Ll Not Applicable
BONDING COMPANY:
Name:
r/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 obtain financing, consult with lender or an attorney bef.oce,
s mencing work or recording our Notice of Commencement.
O
G
-Signatur
Own ee/Contractor as Agent for Owner
Signa - o ctor/License Holder
3�1ATE
OF O IDA
ST OF FLORIDA
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UNTY OF 9(J/1 /./L/.Gli
UNTY C
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forgoing instrucrient was acknowledge jefore me
day r G 20 � / by
The forgoing instru nt was acknowI dged,�efor'
this // day of L 20_[ by
me
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of •
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P d-L D I& n i
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`- Name of person making statement ✓
Name of person making statement
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PersonalI n n OR Produced Identification
Personally Known OR Produced Identification
Type of Identifica on _
Type o en ' . ion
Produced A L
(
Produced
dLl.1
(Signature of No a Public- State of F orida)
(Signature of Notary blic- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
R IEW
REVIEW
REVIEW
REVIEW
DATE
a
RECEIVED
DATE
COMPLETED
Rev.8/2/17