HomeMy WebLinkAboutBUILDING PERMIT APPLICATION, *cr)
r-
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED h
Date: - SCANNED Permit Number: V� l
r-;. _-_ram BY
St. Lucie County RECEIVED
— - -- _ Building Permit Application MAR U 6 2018
Planning and Development Services Permitting Department
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie County
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
,t-
PROPOSEb IMPROVEMENT LOCA7i0N:
Address:
Legal
Property Tax ID #: I�— 7L�9��%cs �� "- Lot No.
Site Plan Name: Block No.
Project Name72, B�f�/
Setbacks Front Back: Right Side: Left Side:
CONSTRUCTION INFORMATION. „
Adartional work .to Be nertormed un ert is permit- check all tatappy:
OHVAC Gas Tank []Gas Piping hutters ❑ Windows/Doors
_S
Electric OPlumbing ,. USprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
S Ft. of First Floor: _
Utilities: Sewer ❑ Septic
Building Height:
OWNER/LESSEE`,',. '"-
,CONTRACTOR:.
Name
Name:
Address-.5Wo 4 -IID
Company:
�y
/rCi
City: l I'
Zip Code/T Fax:
Phone No.
Stater
b 2- y
Address:O
City:
Zip Code?::
Phone No.
Stater
Fax:
E-Mail: n r t-O e 5bC
g p G s h Fr
Fill in fee simple Title Holder on ne
from the Owner listed above)
page ( if different
E-Mail:
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. C &C ��
.'I
5UPPtEMENTALCONSTRUCTION LIEN LR1N 1NFORMRTI01
' i
��.•. r �w. _ter .i�w� �� • � � �
� ..� ,, -- . �� �_�.:`,_ : >, , x
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 holier 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 vour Notice of Commencement.
-4
_mt�-a
ignature of Own r/ Les ee/C tractor as Agent for w er -
lure of Contractor/License Holder
STATE OF FL RID
COUNTY OF �
STATE OF t
` L�IPi�
F
COUNTY OF
jr' 64 41j���
The forgo ng instrume t was acknowledged before me
this -May 20 LA by
The forgoing instWent was acknowledge efore me
this day P PU /e-�• 20 Z by
of
of
1y a r�
Name person making statement
Name of person Ing statement
Personally Known L� OR Produced Identification
Personally Known _OR Produced Identification
Type of Identification j
Type of Identification
Produced
Produced
JU:IE BARR:TTNotary Punic r State oiP,y da ,N
Commissior:(S
Enatur
Wqt r'
(Signaturep Notary Public -State o rida )
?aRR�t
Commission No. �'�"'" nD:e*•,F�;.::(S.•l),!Florida
Commission No.
a \;Ii :a; CDrmissior= GG 243242
' �'- F `. Nu Corm, rx�ires Sr 2?. 2022 P•
„ava,e
i6` ..,p0 YOUNG
_ ., h MY CC,NIMISSION R FF 951069
4'Fa3T
5orc"c:Rr9.u! �.. �:;•� •, i:ASSi'.
uj. •. EXPIRES: AD0112,2020
dr ipkV SQMThral
Agatlidary&Mws
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17