HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `
Date: oZ Permit Number: 1�a `J d U 1 U is
RECEIVED
FEB 2 0 ,
Building Permit Applicati, n
ST Lucie County, Permitting
Planning and Development Services --
Building and Code Regulation Division
Phone: (772)462-1553 Fax: (772)462 1578 Commercial Residential- v /
2300 Virginia Avenue,Fort Pierce FL 34982 /
PERMIT APPLICATION FOR: S
� N�CO�C�S.�DN, �UEMENI QAC T_1( ,N.
Address: !_ l6 C,-/-. i / 3
Legal Description: ! 4 (es l�L�(l7�[/ -
Property Tax ID#: �fr'0 } '® ^� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Additional work to be performe under t is permit-check all that appy:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
� �'a
_Electric _Plumbing _Sprinklers _Generator t/Roof oZ Pitch
Total Sq. Ft of Construction: (e) VQ S Sq. Ft.of First Floor:
Cost of Construction:$ , '5-00 Utilities: _Sewer _Septic Building Height:
`Y Y/ Lf ♦fEE
C_ Name:
Address: Company:
City: State: Address: fl
Zip Code: CPR Fax: City: tate:
Phone No. Zip Code: C Fax:
E-Mail: Phone No 7Q-
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
Lte 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 thepermit 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 our Notice of Commencement.
Signature o caner/Lessee/Contrac gent for Owner Signature of ntractor/Licerise Ho der
STATE OF FLORIDA STATE OF FLORIDA /L
COUNTY OF ��' J I� J � COUNTY OF / �I
The forgoing instru t was acknowledged before me The forgoing instru s acknowledged before me
thi1� day of 20by thi ,ay of t 2010b
(Name of p son acknowledging) (Name of person acknowledging)
( gnatureNotary�Publiic State of Florida) (Signature of N fry Public-State of Florida)
Personally Known V OR Produced Identification Personally Known c//OR Produced Identification
Type of Identification y Stephen P.Frederick Type of Identification Stephen P.Fredenc'--
Produced NOTARY PUBLIC Produced NOTARY PUBLIC
STATE OF FLORIDA _STATE OF FLORIDA
Commission No. C(98"GG048393 Commission No. C �G048393
1 Expires 1/27/2021 119 Expires 107/2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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