HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION To BE ACCEPTED
Date:
UT y
F L �0 R ] 0
Permit Number:
Building Permit Application
Planning and Development Services
Building rind Cade Regulation ulation irisi n
2300 Virginia Avenue, Fart Fierce FL 34982
Phone: () 462-1558 Fax: (772) 462-1.578
Commercial
Residential
PERMIT APPLICATION ICATIO FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
105
Legal Description:
Property Tax ID
Site Plan Name:
Project Name:
Setbacks Front
od 4 h �y'_ v e
5). 7u'--'/ , 0
Back:
DETAILED DESCRIPTION OF WORK:
0
Left Side.
Lot No. '7,,,3
Block No.
x j S -i -m v)��9,0 vnwn -fib ��1C� +w � laves;-l-vy'� S tip i S (gyp ¢ � i CSP. (�u Vl nec v"
PF
CONSTRUCTION I I C I MATI :
3dEtional wa
❑HVAC
❑Electric
o be ertormecE
L_1 Gas Tank
Plumbing
under this permit— check a
Gas Piping
Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
apiy.:
Shutters
❑ Generator
S- Ft. of first door:
EJtiiities:Sewer Septic
❑Windows/Doors
aRoof
Building Height:
Roof pita
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address: 50,
Company:
Citi:P C.)b �1, e:e
LI
Zip Code., F,ax.
City.
.State: �-
No..
Phone ICS. `�- ,� 4
iCode. Fax.f
E-Mail_PhC�F1
o � � i ,� � J
0
Fill in fee simple le Title bolder on next page if different
E -Mail:
from the Owner listed above
State or County Liense:ec
Y
��� ' &.Pci
If value of construction i $2500 or more,, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
I E I+ NE EN INEEI : Not Applicable
MORTGAGE GE of ►NY: � Not Applicable
Name:
Address:
Address:
city: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING oMPANS: Not Applicable
Nar e:
Name:
Address:
Address:
City:
City.
Zip. Phone:
•
Zip. Phone:
OWNER/ CONTRACTOR AFFID IT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation hascommenced prier to the issuance of a permit.
St. Lucie Count makes es no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with an applicable Home Owners Association rules bylaws or and covenants that may restrict or prohibit such
structure. Please consult any
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 wort
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 noxi -residential use
WARNING To OWNER: Your failure to Record l a Notice of Commencement may result in your paying twice for
improvements to your property. A notice of Commencement mut be recorded and posted on the jobsite
before the first inspection.. If you intend to obtain financing, consult with lender or an attorney before
commencine work or re ordine vour Notice of Commencement. �F.F
Signature of Ow .r` Less eye/Contractor as Agent for Owner
TATE of , o f DA � �
COUNTY of
The forgoing intrknowledgeo,,beforeme
this day of 20 b
Marne of person- rnak+ng statement
Personally Known OR Produced Identification
Type of Identification
ProClucedy�.��
Signature of C :r Tractor License Holder
{
TRITE of FLORIDA
COUNT of
The fo Fgoing instrurn
this qday of
owledge l fare me
20 by
Name of perso ling statement
Persona liy marl; OR Produced Identification
Type of Idenrif'ication
• Prod uce�... = '�
-: COMA�11 #
-
=,, •. * . , ExpIm* May 41 202 1
! imded Ehm a 64] 'ice i '*..**• ,*:
(signature of Notary Public- State of Florida ) Signature of Notary Public- State I A a �
Commission No.
(seal)
Commission No.
Edk Names
comminion # GG1 01
Exp[: May 4,
(Seal)
REVIEWS I
NT
I
� SUPERVISOR
I VEGETATION
5
I MANGROVE
COU TER
RONING EVI W
REVIEW
�E �W
REVIEW
1 DATE
RECEIVED
DATE
COMPLETED
Rei. 8f2/17