HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
Building Permit Application APR 0.8 Z019
Planning and Development services ST. Lucie County, Permitting
Wilding and Code Regulation Division
2300 Virginia Avenue,Fort pierce FL 34992
Phone.,(772)462-2553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR; To Select from dropbox, click arrow at the and of line
Address:
Legal Description:
Property Tax ID#: V\S, -ro-a,43,- Go'%ir,- 0 'Lot
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Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side.
��C fDY SqSknq 6ttM q+W
AdidtMoXalwor to rate under is permit-check all appy:
HVAC Gas Tank []Gas Piping shutters Windows/Doors
Electric ED Plumbing Sprinklers Generator Roof Roof Pitch
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction: Utilities: SewerJ Septic Building Height:
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Name Name:
AAA P1
Address:1. A570 Company: t,& , 11 I R A 1 41
City
, /,�Pk(ln State:93 Address: IF659,0
Zip Code: Fax:- 0,_ -twW—e) city: ,
Phone No.. 7Z dg02115L Zip Code•. Fax.710!�_?q9:!27 7,
W11 Phone N
E-Mail.XDffi
Fill In feVsImpleTitle Holder on next page(if different E-Mail:
from the Owner listed above) State orAunty License: 0,Aa 2;�`�
If value of construction is$2500 or more,a RECORDED Notice of Commencement Is required.
0 SIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY., Not Applicable
Name: Name:
Address; Address:
City: State., City: State
Zip: Phone Zip: Phone:
FEE SiMPILE 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.
1 certify that no work or installation has commenced prior to the issuance of a permit.
Acle 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 Homeowners Association and review your deed for any restrictions whlch 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 pians,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
cammencingtwork or cording our Notice of Commencement.
Sign q er Lessee(Contractor as Agent for Owner S! f Contractor/License Holder
ST F FCOR , TE OF FLOR
C. NTY OF G'e COUNTYOF
The f6going Instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of F j I ,2D by this ay cif. t"t � ,2o� by
Name ofp erson aking statement Name of erson aking statement
Personally Known OR Produced identification Personally KnownOR Produced Identification
Type of Identification Type of identification
Produced Produced
CRAIG A.OR >SIiilAN ��'+�� CRAIG A.O $ MAN
.n "•; MY COMMiSStION RF89090^ = • •*= MY commanit}!I 9918"1
(Signature of Notary Public State. . r grata a of Notary Public State } ,� r: 1 ' tl20
Commission No, (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PIANS VEGETATJON SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED-1
Rev.8/2/17