HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ^
Date:�� � �� Permit Number:
RECEIVED
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Building Permit Application JUN 14 201$
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: Ag
Address: L dz Z(Lz U
Legal Description:
Property Tax ID#: �/ `� 6 d- ^ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pertormed under this permit–check all that appy:
_Mechanical Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric /Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �Q�I Utilities: —Sewer —Septic Building Height:
Name - 1 Name.:
Address: 6,61 '' �hSO Company:�
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city: i ttL2, ' State:�C� Address: -_ !a
,Zip Code:- -- � Fax: `� City: :
'N11 State
Phone No.72,�9 _�,�73 y Zip Code: Fax:
E-Mail: Phone No 7W��� 75d
Fill in fee simple Title Holder on next page(if different E-Mail 6h-<45;L
from the Owner listed above) State o C unty License���
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
ROM
s = d � �r�oruw �Na +Mar oN:
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 hermit 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 len an attorney before
comnjenrMl, g-Work2fl6ording your Notice of Commencement.
Si 'a re of Own essee/Contractor as Agent for Owner Sig tur of Co ct icense Holder
STATE`,OF FLORIDA ppS , TE,OF FLORIDA
COUNTY OF o COUNTY OF
The forgoing instr ment was acknowledge before me The fo ing instru ent was acknowledge before me
this�day of v 20 by this day of 204 by
Name of person making statement. Name of person making statement. /
Personally Known OR Produced Identification i✓ Personally Known OR Produced Identification
Type of Identifi ation Type of Identifi ion
Produced V Produced
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(Signature of Nota P - (Signature of Notary Public- lorida)
� � KAREN�SNELSENCommission No. -`a`� ��,State of FlKA
ta.ry Public Commission No. C `�2otMYrpe`n-$tater EL
: . ommiss'lon#GCS 207484 - S N
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l%:lFor��o�� 2022 '.'`ocF�oP`�� SSI Public
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA
COUNTER REVIEW REVIEW REVIEW REVIEW ,\, ,REVIEW -'-REVI
DATE
RECEIVED
DATE \
COMPLETED, \
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