HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICAT.`ON TO BE ACCEPTED p `,
Date:_- i b SCANNEDPermit Number:
BY
'Uml LUDie County
Building Permit Application
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 X Residential
FEB 14 2018
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
FaPROPOSED=IMPROVEMENTVLOGATION:
Address: /O '
Legal Description:
PropertyTaxlD#: 4511 �Sl D 0(9c)n —Doo —D
Site Plan Name: � r
Project Name: AT% �- S'i 5 I z � l G! �f- sE 4
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION'OF WORK
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CONSTRUCTION INFORMATION
❑HVAC U Gas Tank ❑Gas Piping
❑Electric 0Plumbing '❑Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Shutters ❑ IWindows/Doors
Ll Generator Roof ❑ Roof pitch
ScFt. of First Floor:
Utilities: Sewer ❑Septic Building Height:
CONTRACTOR.'.'
Name
Name: EEU,E 7DII10
Address: V
Company � Catm
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City:�'0PEiain—State;
Zip Code:JJ_a Fax:
Phone No.
Address:
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City: f1- (
Zip Code:
Phone No. —
State:_r__C—
Fax:J� Z- 2(?--S.3
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: lolhlor 6
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State or County License: r6G
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If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN'LA.W INFORMATION:
DESIGNER/ENGINEER:
Name: MaXS =/1lCri.1/11F2f�IT
Not A/p�p�l�ica/ble
MORTGAGE COMPANY:
Name:
Not Applicable
Address: 2L l 5F
of fFf �tu/T
Address:
City: <Z
Zip: Phone
State: (._
_
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
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 before
commencing work or recording your Noticiii at GAmMencement.
Signature of Owner essee/ tra as Agent f
r,Qwiier
nature icense Holder
STATE OF FLORID
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The f rgoing instrum t was acknowledg/Vefor
this �f day of,20/ZSby
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The fo{�'oing instru nt was acknowledged befor
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Name of person making statement
Name of person making statement
Personally Known OR Produced Identific
Personally Known OR Produced Identificat r?
Type of Identification
Type of Identification
Produced
Produced
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(Signature of No Public- State of Florida)
(Signature of o ry Public- State of Flo da )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REV EW
REVIEW
REVIEW
REVIEW
DATE
$
RECEIVED
DATE
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COMPLETED
Rev.8/2/17