HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST Bt COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a3 `! SCANNED Permit Number:
BY RECEIVED
St. Lucie County
OCT 2 8 2018
Building Permit Application
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
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 N 4c - M aad III
Address
Legal Description:
..2
Property Tax ID # :
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRiPTION'OF WORK: z "
��i�an �s�zyraYl+
F]Windows/Doors
Roof
Total Sq. Ft of Constructioon::,,-� S Ft. of First Floor:
Cost of Construction: $� Utilities. Sewer EI Septic Building Height:
OWNER/LESSEE,>:yCONTRAGTOR
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Name A`�cr,o\-e-_ `—C-�,hc�,i'
C owre
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Name:
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Address:
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Company:
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City.�)o-crpk . L U c N -
State: _S:L
Address:
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City: �'�le_�A
State: FL
Zip Code: 7_)L-1Gh7 Fax:
Phone No. —\'A - is C�,1 - CL-n
Zip Code:
Phone No.
330i0 Fax:
E-Mail:�\a2r_o��-�ow..�C�mMecc�a0-
Fill in fee simple Title Holder on next page ( if differern
E-Mail:
4 9 00'*0
State or County Lice se: c'0e_1
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i from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. -a 0011
SUPPL``EMENTAL"CONSlRUCTION LIEN LAW INFORMATION `�" .` m
r
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
commencine work or recordinla vour Notice of Commencement.
Signature of ner/ Lessee/Contractor as Agent for Owner
Signature of Cor a older
STATE OF FLORIDA
STATE OF FLORIDA
I ,'
COUNTY OF c'q� U.ICI e
COUNTY OF U414, i YkAo
The forgoing instrument was acknowledged before me
L
The inst en s ckn wledgep fore me
this day f 20I_
thi day of (� `'�.20]Sby
y
Name of person making statement
/
ame of person making state t
Personally Known OR Produced Identification
V
Pers all Known OR Produ d I entificati
''6'.'t",s•''
g
Type of Identification
Tyof I entification
Produced ��PvS\li Q I
Pro uce
$
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(Sign ture of Notary Public- State of Florida)
Commission No. �� (Seal)
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(ign ure of Notary Public-jSt a of Florida
C mission No. I� I (Seal)
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REVIEWS
FRONT
ZONING
f/� R
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
�1fQ
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17