HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
� (� �� Permit Number:
Date:
RECEIVED
Building Permit Applicat on MAR 0 6 2018
Planning and Development Services ST. Lucia County, Pgrmltting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Y_— Residential
PERMIT APPLICATION FOR:
Address: e
Legal Description:
502 to
10,o
• �(;b
Property Tax ID #: ? 0 Q Lot No.
Site Plan Name: Block No.
Project Name. �
Setbacks Front Back: Right Side: Left Side:
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itiona work to be pertormed under iis permit — check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters '�K_Wittrdews/Doors
_ Electric _ Plumbing —Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height:
� � � s
r.,; r _Name: eci✓ %•
--Name;- — --_- j
_
n K _—
Address': :Zw d`' Compan
'City: State Address S
Zip o e: Fax: City: u State:
30 G33 �Co7f� Zip Code: 3"'1 Fax:172-Z8`3AL2
Phone No.
E-Mail: Phone No �72- Z $3 c 4 9 4
Fill in fee simple Title Holder on next page (if different E-Mail E_S / 6oA -7 0 404, CO Al
from the Owner listed above) State or County License ,;J R�
If value of -construction is 2500 or more, a RECORDED Notice of Commencement Is required.
�I
MORTGAGE COMPANY: _ Not Applicable
DESIGNER/ENGINEER: _ Not Applicable
Name:
Name:
Address: -
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
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 before
commencin or or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signat—urLrof Contractor/License Holder
STATE OF FLORIDA/, �
COUNTY OF U.t�
STATE OF COUNTY F ORIDA /��
/ ' / "`�������
The for oing instrum�g� was ack owledged before me
this � day of /� 1 I� /2 20/ g by
The foJgoing instru ent was cknowledge �efore me
this /_ day of � A2G� 20 � by
(Na e f person acknowledging)
(Na of person acknowledging )
�Q
(Sign ure of Notary�P(ublic- rate o Florida)
(Signature of Notary Pub is -State of lorida )
ersonally Known '\ OR Produced Identification
Personally Known
Produced of Flo da
h
Type of Identifg.W]
�2709
,eal)
Type of Identificatia yr Notary Public Slate of Florida
Produced 'P Lisa Greer Bhareth
yt± My GommiWce FF w4lov
qw�' Expims 02ItCommission
Commission No.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
EGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVI
REVIEW
REVIEW
REVIEW
DATE.
RECEIVED
DATE
COMPLETED
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