HomeMy WebLinkAboutpermit application page 2ALL APPLICABLE INFO + U T BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Gate:
COUNTY
R
Permit Number:
Building Permit Application
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia v nu , Fart Pierce FL 34982
Phone: (772) -1553 Fax: (772) 462-1578
Commercial
Residential
PERMIT APPLICATION FOR: : T Select from dropbox, click arrow at the end of lin
PROPOSED IMPROVEMENT LOCATION:
Address: �007 N D�+
Legal Description:
Property Tax ID #l:
0l�
D
Site Plan Name: Block No.
Project Darns:
Setbacks Front
Back:
DETAILED DESCRIPTION OFWORK:
r
Y i a /0.1 J -V
CONSTRUCTION INFORMATION:
witionai wo
❑HVAC
Electric
o ae errormed
Gas Tank
Ful
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Right Side: Left Side:
PC'�;TKrC (J)-kY
unaer tnis permit — ene
;Gas Piping
Sprinklers
Shutters
Generator
Windows/Doors
Roof
S. Ft. of First Floor:
Utilities: Serer Septic Building Height:
Raaf pitch
OWNER/LESSEE:
CONTRACT -OR:
Name1(ice/o V
Name:
Address: 90 7 � � F
Company:
City. Stat.Address:
Zip Code: 43 YQ Y2 Fax:
City: Stag:
_
Phone o N �`` �, .�
i d Fax;
p Ccs
E-mail:
Pyrone N.
Fill in fee simple Title Holder on next page if different
E-mail:
from the Owner listed above)
Stag or County License:
If value of construction is $2500 or more, a RECORDED RDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
E I NE EN I1 EE : Not Applicable
MORTGAGE COMPANY: Not Appii ble
Name:
Name:
Address.
Address:
City: State:
City: State:
Zip: Phone _
Zip: Phone:
EEE SIMPLE TITLE HOLDER: : Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
city:
Zip: Phone:
Zip: phone:
OWECONTRACTOR AFEI IIT: 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, per -form 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 Bali concurrency renew: room additions,
accessary 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 wakr recordiniz vour notice of Commencement. �.
Signature of er/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTYOF
�����C�'�
The forg9in instru ent eras nowlede efore me
this � d a of 20
f 0 by
Name of person rnl statement
Personally Known m Produced Identification
Type of Identif.cation
Produced .
r •,IM
(Signature of Notary Pu ridt�=Wton
GGIO144.
Commission No. . el0ra May, 2MI
.onded thru Aaron Not"
Signature of Contractor cense Holder
STATE OF F LO I f
U T'of d
The for ming instrum t was actino ledge efore m
this da of r : �g by
ell
Name f person. akin statement
Personally Known P duced Identification
Type of ld�entifi 4 n
Produced t¢
s
A.
V_Y�nature of Notar)r-IIS i t Mor'
,. Wan 1442
rrirl"r'rssiorl No.Nk 4,2021
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Rev. 8/2/17