HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED :
Permit Numbe / Fo�/��
Date: -
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Building Permit,Application
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie Cc i 1` y f FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: 4
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PR®POSED l'NPRIUfMENT l.00ATIN:
Address: 5-0 . h %¢c 41,qy 0,9/�9 XA . FT• 01EtzCC- FIA-
Legal Description: ,
Property Tax ID#: � y�� ` 2: 2 OOOZ —030.- S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks. Front Back: Right Side: - Left Side: aL
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CONSI"Rl1CTION lN,FO iMAT ON:
Add! I work to be performea uncier this permit-c ec a t at Sapp y:
_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:$ O-V• ry. Utilities: —Sewer _Septic. Building Height:
4 N �R/LE�S�S r E• CaNTRACTQR:
Name le AN lC L (J N P-) Name:
Address: 37 SD Wh � � CRJr+y /ai�y /�Q_ Company:
City: f" P/ State: /. Address:
Zip Code: Y/980" Y?Fax: City: State:
Phone No. cP0 /-yy S'0 Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
- from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice�of Commencement is required.
S�UPPLEMEN A CONS RUCTION IEM, LAW P FORMATION:
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
commencing work or recording our Notice of Icement.
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Signature of Owner/Lessee/Contractor as Agent for2 a Signature of Contractor/License Holder
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STATE OF FLORIDA - s OR�$ STATE OF FLORIDA
COUNTY OF oa COUNTY OF
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The for oing instru nt was acknowledgeforem m The forgoing instrument was acknowledged before me
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this day of ��` ' .20Vby a�`•"• d:.oma this day of .20_ by
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Name of person making statement. / Name of person making statement.
Personnown OR Produced Identification (/ Personally Known OR Produced Identification
Type of Ide f' ation Type of Identification
Produced Produced
(Signature of ary Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
�e_v_. 8/2/17