HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �d �� Permit Number:
RECEIVED
' - - FFR 10 Jl8
- Building Permit Applica ion
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:
FIVOC
Address: d is
Legal Description:
C' c� _z T__
Owl 6'a _ ("rt
oY� R 3
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
-;7
Additional work to be performed under this permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors l�
_Electric _Plumbing _Sprinklers _Generator (/ Roof J/ / Pitch
Total Sq. Ft of Construction: %I 1rO d sa('Ffi�. Sq. Ft.of First Floor:
Cost of Construction:$ 3,;_-SUS ' '�O Utilities: _Sewer _Septic Building Height:_alkrz
e Name: fJ e
Address: � �� U Company:
City: State:State: Address: 4, 0
Zip Code: Fax: City: State:-[---:i_
Phone No. Zip Code: Fax:
E-Mail: Phone No —7 "7A
Fill in fee simple Title Holder on next page (if different E-Mail 1t . '
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: —Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _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 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 recordin&your Notice of Commencement.
Signa! of Owner/Lessee/Cont r as Agent for Owner Signature of Co actor/License Holder
STATE OF FLORIDASTATE OF AU-6;'t
J l�� 1 � COUNTY OF FLORIDA "I— fll
COUNTY OF / , �
The for q. instr was acknowledged before me The for qqi��g instru en was acknowledged before me
this Rr'day of a. 201f by this, T�lay of 20X by
_YA We 3aLs ��7-4-(wr(�
(Name of person acknowledging) (Name of pers n acknowledging)
(Signature of f0tary Public-State Florida) (S' nat a of N ary Public-State f Florida)
i
Personally Known 0 edNS alff0rick Personally Known �� r du nbif �x
Type of Identification NOTARY PUBLIC— Type of Identification NOTARY PUBLIC
Produced o _STATE OF FLORIDA Produced E OF FLORIDA
arms#GG048393 Comm#GG048393
Commission No. 9 EqkqT 1/27/2021 Commission No. t ExpirW-l47/2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.