HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BtCOMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: O
RECEIVED
Building Permit Application JUL 0 2 201
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: 1 �
PROPOSED LNPROVEQ,,I I 19 ITI LOCATION:
Address: ?>< U
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: ' Right Side: Left Side:
QE?AI'LED � E�SCRIPTION OF WOR
CO" YY1
c vNap O "r. DML ,wiLto ANA
I tq9 d Lb 'bI N 4
CONSTRUCTfON LN1=0RMATION:
.'Additional work to be performed under tis permit=check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
/Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ ` �,� Utilities: —Sewer —Septic Building Height:
OWNER/LE=SSE CONTRACTOR;
i .R!<[,R ?Name:
Name i
Address K (� (Company: I �l G J C.
State: FL nAddr ss
Zip Code: Fax: City: State:FL
Phone No. Zip Code: � Fax:
E-Mail: Phone No
i
Fill in fee simple Title Holder on next page (if different E-Mail 72�QAOL . 49rt l
from the Owner listed above) State or County License
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CO'NSTRU'CTION LIEN LAW UNORMATION:
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 permit 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
commengiqg work or recording our Notice of Commencement.
Z,; n _94a,_�
Signature of Owner/Lessee/ ent tire-of Contracto License Holder
STATE OF FLORIDA STATE OF FLORIDA-
COUNTY OF e+L,.-,r c-e— COUNTY OF,.-.----' S
The forgoing instrument was acknowledged before.me The forgoing instrument was acknowledged before me
this.-�day of 20� by = this�day of 209 by
4r4L,,r 'tis AY-4 —
(Name of person acknowledging) (Name of person acknowledging)
ig ature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida)
Personally Known P Personally Known V__�OR Produced Iden ificatLorL
Type of Identification VITTORIAWEBB Type of IdentificationE'�F
VI170RIAWE88
`r°; Gam: Nota Public-State of Florida
Produced Notary Produced tary Public State of Florida
ommission#GG 211970
Commission b GG 211910Commission No. My Comm.Expires Apr 29,2022 m Ex iresA r 29,2022�°�a rl P PBondedt(�6ONationalNotaryAssn. Commission No. Ntfirug 1NatlonalNotaryAssn.
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