HomeMy WebLinkAboutBuilding Permit Application .1r,"
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Numberd-9 1 (3
RECEIVED
Building Permit Application NOV 12 2019
Planning and Development Services §T. 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
PLICATION FOR: To Select from dropbox, click arrow at the end of line
Legal Description: =r'
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PropertyTax ID#:gS35 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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GR PNIW(S P,
,IaR�JN RN 1011
AdditionaTworKTODeDerformed under this permit—check afFtbat apply:
7HVAC Gas Tank 7 Gas Piping 7 Shutters IzWindows/20—OIrs
Total Sq.Ft of Construction: Sq. Ft-of First Floor:
Cost of Construction:$ Utilities: Sewer Septic Building Height:
Zip Code:3-(-ig S 7) Fax: city:i State:
Phvnq No.— Zip Code: Fax: �7LJ
Fill in fee simple Title Holder on next page if different E-Mail:
from the Owner listed above) State or County License; 0 6_-7 C,c', s.1.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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5;UPe �Nfi' STRUCTION LIEN LAIN INFORMATION
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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:
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 per"mit 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
commencinR yvork Qf recording our Notice of Commencement.
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Si ature of Owner Lessee/Agent S' na ure of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORLDA /
COUNTY OF /"GC./'�/Yj COUNTY OF YG�IlM genC lel
The forgoing instrument as acknowledgefore me The forgoing instrum nt was acknowledged fore me
this Z� day of 20 by this Z day of , 20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Sign re of Nota Pu�OR
e of Florida)
Personally Known OR Pro ed Identification Personally Known ✓ roduced Identification
Type of Identification Produced �/ "7415e Type of Identification Produced
Commission No. "'GT � 3
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ROB RT RIES MY COMMISSION#FF 951069
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Commission#GG 269505 FOF moa soma Thru audget Noory somca5
Revised 07/1S/2014 My comm.expires Oct.18,2022
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