HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPUCABLEJNFQ MUST BE COMP, _ED FOR AOPLICA70N TO BE ACCEP D I /p� r/� r
Date"` ( Permit Number: l - V GPI
SCANNED
y , BY
St. Lucie County
Building Permit Application RECEIVED —
Planning and Development Services JUN 0 8 2018
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 ST. Lucie county, permitting
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residentia -
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �b ;qN
Address:
Legal Description: t)iXX%
Property Tax ID #:
Site Plan Name:
Project N
Setbacks
NT LOCATION:
U.S.
S10-AN UN4
N Jh WAS 16
nI _onz�z (yy-)
3
Right Side: Left Side:
Block No.
DETAILED DESCRIPTION OF WORK: III
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CONSTRUCTION INFORMATION: III
AaamonaiworKtoo rrormea unuerims erm L—GneGRau appry:
❑HVAC Gas Tank as Piping _ Shutters
Electric1:1 Plumbing r Sprinklers Generator
Total Sq. Ft of Construction: (� `l D OO -1'� Z S Ft. of First Floor.
Cost of Construction: $ J Z G O UtilitiesInSewer OSeptic
Windows/Doors
Roof = Roof pitch
Building Height: ao
WNER/ SS :
CONTRA O
:
ame•
Address:
City: 2 State:�L
Zip Code: J�_ Fax:
Phone No.
Company: 3
Address:
City: nClZ, Stater
Zip Code: 1� i Fax:
� �
Phone
_—
E-Mail:
(OH30
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
'-
E-Mail: 30
State or County License: s �rJ
If value of construction is 52500 or more, a RECORDED Notice of Commencement is requires.
PSG e
SUPPLEMENTAL
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone
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
r.,... .nrino %e,nrk nr rornMinw vnur Notire of Commencement.
Signature of O ner/ Lessee/Contractor as Agent for Owner
Signat r f Contractor/Li ense Holder
SOF TATE
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The fo oing instrument was acknowledge before me
Y
The fo ing instrumenQt was acknowledgg efore me
f`t'1/i� 20 I by
this day of n1fF% 20 by
this of
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nTday
RCJDeOic \WAMe✓
Name of person making statement
Name of pe on making statement
Personally Known OR Produced Identification
Personally Known � OR Produced Identification
_
Type of Identification
Type of Identification
Produced
Produced
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�
(Signature of
N4, "''. !?ublic-§ AF�19k*dIS
(Signature
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Commission
' n7093
MY COMMISSION�(� e0F020
COmmissi
SOPHIA HARRIS
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SMe
(407)398-0153 FlneaN.Wa S.m..<
EXPIRES May 30, 2020
(407)399-0153 FIOfN1a O4 NSGNJ1 .Mm
REVIEWS
FRONT
ZONING
I
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
�I
1p
RECEIVED
l7
DATE
COMPLETED
Rev.8/2/17 (//