HomeMy WebLinkAboutSLC Permit AppALL APPLIll INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater R Permit Number:
a
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 452-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 5 \- W L f
Legal Description:
0
Property Tax ID #`��� �, `� Y Lot No.
Site Plan Name: C C �—C Block No.
Project Name: _ \ t ('.
Setbacks Front Back: ight Side: Left Side:
DETAILED DESCRIPTION OF WORK:
v',lI IST CYO. C,�l 7DOC,.(
` v \ -l"I)vc
CONSTRUCTION INFORMATION:
Additional wor to e e orme unii er t is permit - c 12 3: a 11 app y:
OHVAC Gas Tank DGas Piping _ Shutters windows/Doors
11 Electric Plumbing o Sprinklers Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: Scl. Ft. of First Floor:
C
Cost of Construction: $ Utilities: 0 Sewer 11 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
N
Address: ti `Ll-
City:- cam's`. State:
Zip Code: �\�l -I l ! Fax;
Phone No.
Fill in fee simple Title Holder on nem page (if different
from the Owner listed above)
Name:
Company:
Ad"OJ - ,
City State:l ---
Zip Code: cl Fax:�t b
Phone No.
E-Mail:1 feco y�
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRU
DESIGNER/ENGINEER:
Name: _
Address:
City:
Zip:
Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:.
City:
Zip: Phone: _
N LIEN LAW INFORMATION:
of Applicable
State:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Applicable l BONDING COMPANY:
Name: _
Address,
City:
Zip:
Phone:
Applicable
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
structure. Please consult w thpyoiur Home Owners Association tiandr review your deaws ored or and ny re restrictions nts that wh ch may apply.rict orprohibit such
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 wo*9P,,"
, x9rdin&your Notice of Commencement.
ture of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF L� �'�L-�
The for oing instru a as a knowledge fore me
this day of t e"# ZO by
(Name of
(Signature of Notary Public- Sta�-dof Florida )
Personally Known lam' s. i,o duced identification
Type of identification Jd '
Commission No. `: o�b*°��i,�l Ij
Lya
110 1?76
Revised 07/15/2014�i,, Po
NN- -
REVIEWS
FRONT
ZONING
COUNTER
REVIEW
DATE
COMPLETE
INITIALS
der
STATE OF FLORIDA tt f
COUNTY OF �, -
The f9rijoing instrument wa4 acknowledge efore me
,
this L day of e 20 r�� by
r�
(Name of er a nowlle�edging )
(Signature of Notary Public- fie of Florida }
Personally Known I/ G ced Identification
Type of Identification Pr
:.: a�I'hy
C %
Commission No.
4?0
IEWS,OR REVIEW VEVI WON I SIATURTREV EWLE RWVE