HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /� "L'
Date: Q - (P " aciac) Permit Number: ��(/o Qto T
Building Permit Application RECIETIft
Planning and Development Services FFB Os
Building and Code Regulation Division Pe nni - 0 ?0
2300 Virginia Avenue, Fort Pierce FL 34982 St• h1,9 QPa
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential eounn"'ent
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal Description:
Property Tax ID
Site Plan Name:
Project Name:
Setbacks Front Back:
1JHVAC
ElElectric
Plumbing
— yhcic- S-
Right Side:
Left Side:
Generator
Lot No. (D (o
Block No.
Windows/Doors
Roof = Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 63H 0, O ci Utllitles:Sewer DSeptic Building Height:
OW.,N /LESSEE: "
GO.N ARi C OR:
Name rl P, hJoO n
Name:
Address:l S
Company: 'r:7okcy -perm
5 em5
City: S� V State: �l
Zip Code: 'Y4 1q�:g Ln Fax:
Phone No. c�cO,�'?YQ5- 43pC)
Address:l60 Smo kjw0
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City: A -t pl c(e,-c Stater
Zip Code:' 4CIS a Fax:-11QL (DV-)M-1
Phone No.
E-Mail: k'lewcoeaN CCU �•�otn
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: v
If value of construction is $2500 or more, a RECORDED Notice of Commencement is.required.
SUPPLE- E TALCONST UCTLON LI€N LAW IN.FQRMAiTLON
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 accessary 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
as
STATE OF FLORIDA may— IPSTATE OF FLORIDA
COUNTY OF �] t ,k3 � COUNTY OF �T �^ U
The forgoing instru ent was acknowledged before me
this�dayof 20A0by
Qr hef• IQ Zr C IlCkii:Jk
Name of person making statement
Personally Known --,A OR Produced Identification
Type of Identification
Produced
of Notary pudf ic- Srte of
Commission No.
REVIEWS I FRONT ZONING
COUNTER REVIEW
DATE
Rev.
BNh
The forgoing instrument was acknowledged before me
this —Ldayof lzikruCk20,rnby
�d�er�. �Zre.1lQeJi'.
Name of person making statement
Personally Known V OR Produced Identification
Type of Identification
(Signature of
gry Public Salta i
iherly Large
Commission GG
,Ims 12126/2023
UPERVISO
S REVIEW R I REVIEW I PLANSV REVIEW ON I SEREV EWLE I MANGROVE REVIEW