HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1103 - CN(;/
RECEMD
Building Permit Application MAR 2 8 2010
Planning and Development services Permitting Department
Building and Code Regulation Division �" St. Lucie counts.,
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-
1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: C) e
Legal Description:
Property Tax ID#: 1 --? oy j c1 U Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION'`OF WORK:
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CQ,NSTRUCTION.INFORMATION
Additional work toeperformed, under tispermit—checka appy:
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$_ 20(D& Utilities: D_Sewer[]Septic Building Height:
OV1JN ER%LESSEE.`` `'CONTRACTOR:
Name - L.y CSC C'rSisn y Name: 5NMC M 'AT"U (
Address: Company: L
City: State:_ Address:
Zip Code: Fax: City: State:
Phone No. Zip Code: E 9 Z Fa
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: 5F2C U
from the Owner listed above) State or County License:��5 [U43
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION UEN•LAW INFORMATION:,
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.
Signa re of Owner/Lessee ontractor as Agent for Owner Signa a of Con ractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Z51 LUc-ie COUNTY OF L,.-ie r
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this qday of ~�h 20•lr by this "day of 177171t r 20_Lf-by
S 2 �z E!t �-S ()n/-'U I J�
Name o person making statement Name of person making statement
Personally Known OR Produced Identification_ Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced �, L Produced L�
( ignature of Notary P c-State of Florida) O (Signature of Notary Public-State lori a) o
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Cr a C' m
Commission No. (Seal) O` X N Commission No. (Seal) O; N
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REVIEWS FRONT ZONING
$(7 PLANS VEGETATION SEA TURTLE IVIANG 6 N
COUNTER REVIEW /Im REVIEW REVIEW REVIEW REVI " E
DATE =W 0� wmo
RECEIVED U
DATE ti's%
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COMPLETED '
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Rev.8/2/17 -
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