HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONBALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �, - s- t n Permit Number: - OO A5
SCANNED
BY
St. Lucie Cou RECEIVED
Building Perm NyApplication
Planning and Development Services APR 0 3 2018
Building and Code Regulation Division
ST. Lucie County, Permitting
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
PROPOSED_'IIVIPROVEMENT LOCATION: :' '71 1 .� •-^
Address:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side:
DETAILED DESCRIPTION'OF WORK:-',
CONSTRUCTION INFORMATION:
Left Side:
Lot No.
Block No.
AUUILIUIICPWVIK W ae CI IU[ neu unuel uus penmi-alecK an appry:
❑HVAC Gas Tank ❑Gas Piping _Shutters ❑��f//WJindows/D$rs� �
❑Electric ❑Plumbing []Sprinklers ❑Generator L7M L oof�fpitchTotal Sq. Ft of Construction S Ft. of First Floor:
Cost of Construction: $ c� Utilities., ❑Septic Building Height:—L�
roll), 1W
._ it :
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
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If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAIL CONSTRUCTIONLIEN LAW INFORMATION
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 No c oe f Commencement may result in your paying twice for
improvements to your property. A Notice offCaffimencement must be recorded and posted on the jobsite
before the first inspection. If you inten obtain financing, consult with lender or an attorney b"efore
commencing work or recocdine voLLWotice of Commencement. 1 /
Signature f ea/Contractor as Agent for Owner
Signature of 1 5for/License Holder
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ing statement
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ng statement
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Personally Known
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Type of Identification
Type of Identification
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Produced
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REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17