HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLEY-ED FOR APPLICATION TO BE ACCEPTLu
Date: Permit Number:
SCANNED
BY
8t_ Lucie Coi.int, RECEIVED
N -B9 Building Permit Application NOV212018
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:
Address:
Legal Description:
PropertyTaxlD#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: _ Right Side: Left Side:
—Mechanical — Gas Tank — Gas Piping — Shutters —Windows/Doors
— Electric — Plumbing — Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
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Zip Code: Fax:
Phone No.'.
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Zip Code: j�q,%Z_ Fax:
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E-Mail:—
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail i M -A w n k/Q CQ)6�croall
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State or County License. 7_9% U
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: —Not Applicable
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
commencing work or recording your Notice of Commencement.
Signature of O—wne?�'f�see/Contractor as Agent for Owner
SignJt4Fe-dW6trJR'b_r/Lice se Holder
STATE OF FLORIDA
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STATE OF FLORIDA
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COUNTYOF )("lp.
COUNTYOF ucie
The f9parcing instrurvedt was acknowledg-A before me
by
The forgoing i�nstrum t was acknowledged&efore me
thisi:j)l day dm 20 11D by
of.
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Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification t.//
Personally Known OR Produced Identification
Type of I&ntifil!�'on
Produced—
Type of Identific)?797'
Produced—
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(Signature�cf �Notary ublic- State of Florida
Commission No
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