HomeMy WebLinkAboutBuilding Permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED :�d�
Date: �/ itJc b Permit Number � r k
II + RECEIVED
• - ilk APR 2-1 2070
Building Permit Application
Permitting Department
Planning and Development Services St.Lucie county
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:
Address: qy/dA
Legal Description: 0a4d oc.-V OC✓ 4/19 C>11,- 1'0
Property Tax ID#: Lot No.
Site Plan Name: /1//Ft Black No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Additional work to be pertormed, ;un er t„ is,permit-check all that appy: } -
Mechanical _Gas Tank _Gas Piping Shutters `Windows/Doors
Electric —Plumbing _Sprinklers `Generator _Roof Pitch
Total•Sq Ft of Consfr6aion:' ;` - - Sq. Ft.of First Floor:
Cost of Construction:$�,9 /his?- Utilities: ..:_)Sewer _Septic Building Height,'XW
Name Ac 5"+s'L} Name.�" A
Address: .. lb C�4r,�4 �i�• Company:C.0 a�f. S �i_./�7��vJ �'
City: State: Address: if.2
Zip Code: 3 �'g3�.. Fax: A/ _ City: & 4.elre State:
Phone No. -%.S ��^ Zi Code. c�
y6�.�' � p ��1� l t�:... ` Fax: ?72• V6 ,.t
E-Mail: Phone No 7,7,4-V61- e2�1�,i
Fill in fee simple Title Holder on next page(if different E-Mail 1.7 C ee y'c/?*p• C0^4
from the Owner listed above) State or County Licensed'CG13t/s'/So I
!f value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:
Name: i Not Applicable
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 Associationrules,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'respect's,iperform 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,
accessorystructures,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
commencingwork or recordingour Notice of Commencement.
Signat re of Owner/Le see/Contractor as Agent for Owner ignature of Contractor/License Holder
STATE OF FLORIDASTATE OF
COUNTYOFS}• �G`1E COUNTY OF ORIS • LCICIF
The forgoing instrument was acknowledged before me The for ing instrument was acknowledged before me
this J day of }y 121 L 20ZD by this L 20 ZO by
SN P3,
Name of person making statement. Name of person making statement. /
Personally Known OR Produced Identification Personally Known OR Produced Identification ✓
Type of Identification Type of Identification
Produced FWEXVA Oe-we?, Ucurzr_ Producedf�_-l.D Dallee, LA"-Mv,
43tip�P'c
4giniatf-ure-of Pu tate of Florida oo��a�¢°�°� tioti �. ( gnatureof Notary is-Stat or' F.
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Commission No. 6Q,I OCI O�� (Se ��ss�O}Qa o�a�� Commission No. `0. LS Fria
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REVIEWS FRONT `� SUPERVISOR PLANS VEGETATION 5E C7RMANGROVE
COUNTER VIE REVIEW REVIEW REVIEW REV REVIEW
DATE
RECEIVED
DATE
COMPLETED
Mev.