HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
.•,J. _ � RECEIVED
Building Permit Application AUG 15 217
Planning and Development Services Permitting DepartmentSt. Lucie Count
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
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Address: IL
Legal Description: Gn q C bi n S A- - �C a nidAdbn
Property Tax ID#: 9�`rG l - l..l'U 5 - Lot No.
Site Plan Name: rn1C I on C4 Block No.
Project Name: nn Ll �)n E+
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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[CONSTRUCTION INFORMATION:
I
Additional wor to be nertormed under this permit-check all appy:
e JNVAC Gas Tank ❑Gas Piping In Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers M Generator Roof Roof pitch
Total Sq. Ft of Construction:S-1 1 U �) , () D S . Ft. of First Floor:
Cost of Construction:$ ® Utilities:Sewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name _ Name: u
Address o Company: (� 4, 1 1
City: State:F—�- Address: 'n a t'Yl
Zip Code• �O o Fax: City:��1 1A V- State: FL
Phone No. f ' ' 5Zip Code: Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: nif ( I/(1
from the Owner listed above) State or County License: n
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not
Name: Name:
Address: Address:
City: State: City:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not
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 instal
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 su
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict
structure. Please consult with your Home Owners Association and review your deed for any restrictions which ma,
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects,perform the
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-resid(
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying
improvements to your property. A Notice of Commencement must be recorded and posted on
before the first inspection. If you intend to obtain financing, consult with lender or an attorney
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA j\A0,J STATE OF FLORIDA ��COUNTY OF V COUNTY OF
Th going instca ent s cknowledge efore me The orgoing ins nt w s Sknowledge e
thday of 20 by thi ay of 20�I
Name of persoryhiaking statement Name of person paking statement
Personally Known OR Produced Identification Personally Known OR Produced Ident
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Pblic State of Florida) (Signature of Notary u '" ate a )
SNIFF M
Commission No. = _ ASHLERSS ELTRq Commission No. r4'Ni MYCpMMSeFLT�N N
= MY 0 ENA °j� o, EkP� 'J ON FF F A
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REVIEWS FRONT ZONING PLANS VEGETATION SEA TURTLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17