HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c�
Date:va, Permit NumberA'q a �� 1
RECEIVED
_ Building Permit Applicat on DEC 13 G31B
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: ��
PR@POSED INPRtUEME T Lt?CATt®
Address: Sf
Legal Description:
3y1q_ 5�c�� Oa.dy- dau -
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name: 75W - //��
Setbacks Front_ Back: Right Side: A� Left SideA(/
4,7
DET' ICED DESC IPT(ON OF WQRK;
CONSTRUCTI N INF7.
OR M A-09 NS
'Additional work to be pertormed uncler this permit--check all that appy:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Constructiq* Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
OWNER�LE#S�S� CONTRA OR:
Name g Name:,
Addre o ' Company: �U 9
City: ral State AddressLA
Zip Code: Fax: �–/ City: V State:
Phone No. �Dl 25 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.
SU�I�PLEMENTA CQNSTRtJCT'i�N l:I�E LAW GNFORMATiQN:
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 Commencement.
Sig ture ofrO - e /Less /Co actor as Agent for Owner Si ature of o tractor Lice Holder
STATE OFIDA STATE OF FL ID
COUNTY OF Sir'. 1.y C1 COUNTY OF �-. t-'
The forgoing instrKnent was acknowledgeobefore me The forgoing instrkment was acknowledged before me
'3
this\ day of "tC 20by this day of 1)Q 20L'q by
Name of persod making sta ement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of ldentif ation
Produced Produced
(Signature of Notary Pu -State of Florida 1__� ,.�A�s (Signature o UL, ��+
"�':' l"":::'• DEANNAMARIEGIVENS
QSANNAMARIEGNENS N _ ,
Commission No. My wihsloN#GG 022023 Commission ;. SION#G�
w ••:op EXPIRES:DecemUe06.7.020 FF�o?. Bo e�pu6elioii
ndod Thrr Notary underwriters i
..oa,= Bonded Thru Notary Public Underurtilors ,� ,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17