HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:SCANNED Permit Number:
BY
r� W " �i" St. Lucie 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
MAY' 2 3 2018
Permitting C®partmsnt
St, Lucla County
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line I
Address:
Legal Description: —1 3S L-\C:) C \ 1 a Oq F�J E \ k-1 O-�' (v F I (L{
PropertyTaxlD#: ori�O�' �`�—Q��—QCSJ-3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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11 Electric
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Gas Tank ❑Gas Piping _Shutters
Plumbing Sprinklers FI
dPP1y:
Generator E
Windows/Doors
Roof = Roof pitch
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Total Sq. Ft of Construction:
'' II L Sq��Ft.I of First Floor: _
Cost of Construction: $ ` LA -L l Utilities: LJ Sewer ]Se
Building Height:
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Name \C cs
Address: `\\Olo Mca(--%C&) r
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Zip Code: 3LQ� _� Fax:
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Zip Code:\�g� Fax:
Phone No. —r�i-1 3- L\� C0) lo?ciJ
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail TLnV �S�CC�GaolS�� L
State or County License:
It value of construction is 5Z500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMITAL CONSTRUCTIO,{V LIENLAW INFORMA�IQN,
U '
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 obtain financing, consult with lender or an attorney before
commencing work or recordine vour Notice of Commencement.
Signature of Owner/ Lessee/Co tractor as Agent for Owner
Sig�r ature of Contractor/ricense
Holder
STATE OF FLORIDA
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STATE OF FLORID�
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COUNTY OF [5�
COUNTY OF �
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The for ling instrument was acknowledged before me
The forggoing instrument was acknowledged before me
thisQdayof� 20VG by
thiscR dayof
20_\K by
Name of person making statement
Name of person
making statement
Personally Known ✓ OR Produced Identification
Personally Known V
OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- StaNe of Florida)
(Signature of Notary Public- StAQ of Florida )
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Rev.8/2/17