HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 71 i SCANNED Permit Number: 0 I�
BY
St. Lucie County
RECEIVED
Building Permit Application
Planning and Development Services AUG 16 2018
Building and Code Regulation Division I 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 III
Address: "jJIJ�
Legal Description:
Property Tax ID #:
Site Plan Name: _
Project Name:
Setbacks Front
FL 2AqR
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Left Side:
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Lot No.
Block No.
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11HVAC
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Gas Tank
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❑Gas
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Piping
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Shutters
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Windows/Doors
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11 Electric
0
Plumbing
Sprinklers
Generator
0
Roof
=
Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ ��� Ov Utilities:n Sewer E]Septic Building Height:
OWNER/LESSEE:` "=
CQNTRAC�T.OR:a''
Name i (
Name: S
Address:
ompany:
City: StateFL.
Zip Code: 5gR,9a, Fax:
Phone No, r n 3
Address:,Wq�nm
City: State:��
Zip Code: aJ1�') Fax:
,Phone No.
- _ r
E-Mail: r>h(lU3iC711 C ,Qn�r CC�Yt SoU1d1YAI��+,,r,5
Fill in fee simple Title Holder on next page (if different
rot the Own, listed above) l YYl
E-Mail: 1 R Q Q
State or County License: U o1401
If value of canlstruction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
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 con lict 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. f you intend to obtain financing, consult with lender or an attorney before
commencin or rec dine vour Notice of Commencement.
_ gnaTufe.5f[Qwn�/ Lessee/Contractor as Agent for owner
Si6t(inature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF JyI� .�
COUNTY OF �/la�tin
The forgoing instrument was acknowledged }efore me -
The.for�going instr ent was cknowled before me
this � day of May 20 V � by
this day of 20 by
nip nwCAM e!�
Name of person making state
Name of person making statement
Personally Known O roduced Idenlia
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced M 23 15 i 30 G7 3
Produced
(Signature of Notary Public -State of Florida ) a
(Signature of Not ry,,•,u; ic-
/� J �% -�
Commission No. t 0TI L1(Sealjl P p
:,. ^.;:•. MIA QUINTERO
Commission No. ..+:: � My COMMISS((5aa1 F927603
.
•91j :(,,+ EXPIRES October 14, 2019
Fblyrryp�a Sn•vir4.aom
REVIEWS
FRONT
ZONING
SUPERVISOR
PLA
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
RE
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17