HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Nurn
BY
��t Lucie County
Building Permit Applicatioi
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34992
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
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SEP 13 2018
Permitting De.partment
St. Lucie County, FIL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
1,PROPOSEO,lK4PROVEMENT'Lb,cATio'N.�;,-,� %
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Legal Description;
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PropertyTaxlD#: -(O."o -ools- 0 C)ej Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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LJHVAC L.1 Gas Tank
11 Electric 1:1 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 1. 6 !� C)
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Piping L.J Shutters
nklers OGenerator
S Ft of First Floor:
Utilities. -In Sewer OSeptic
Windows/Doors
Roof = Roof pitch
Building Height:
CONTR
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Name: '\.Se.PL'
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Address:— )�lvd\
Company: F1 O� �t;-g
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City: state:
ZipCode: �Llo�oio Fax:
Phone No.
Address: 151 ST-:
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City:
Zip Code: '34 W4
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State: I L
19 lok
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: C rn4LCr_5 1*�'
State or County License:
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
S-UPPLENfE ONSTRUCTIONII-EW-LA
7
DESIGN ER/ENG I NEER:
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 Count makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conxict with any applicable Home Owners Association rules, bylaws or an9covenants 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 recording your Notice of Commencement.
Signature of Ownfr/ Lessee/Contractor as Agent for Own6f.—
Slonat tor/License Holder
STATE OF FLORIDA
7
STATE 0; ORI'DA
COUNTY OF
COLIJ OF
The forgoing instruynt was acknowledg before me
71
The forgoing instrument was acknowledged before me
this day of 20f?by
this _!�J -day o f L�4 A 2 0 1.�'b y
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
own OR Produced Identification
Type of Nentification
Type of I en ification
Produa6d I
JPersonall
Produc
lignat&e of —Notary PubElc_ State of Florida
/gnature oNcliary Public- State of Florida
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
I DATE
I COMPLETED
Rev. 8/2/17
NN Note Public State of Florida
. Lisa Greer Bharath
Public State of Florida t to