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HomeMy WebLinkAboutBuilding Permit Application Amok a All APPLICABLE NFO MUST BE COMPLETED FOR APPLICATION.TO BE ACCEPTED ^ Date: Permit Numbe `le Vol �`. tnrV 20LU Building Permit ApplicY Im Planning and Development Services Building and Code Regulation Division St. Lucie CC?unt)f6 _a j 2300 Virginia Avenue, Fort Pierce FL 34982 w Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: Address: Legal Description: Property Tax I D#: 0 063—©Q 0 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: • D TAILED DE�SCRIP ION OF WORK: U CO'N R I©N I OR A ION: Additional wor to epertormed under t -is permit–check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors' _Pond _Electric _Plumbing _Sprinklers _Generator _Roof Pitch Total Sq. Ft of Construction: :3p ® Sq. Ft. of First Floor: Cost of Construction: $ �D_ � Utilities: —Sewer —Septic Building Height: 0 NER/LE�StS E: CONTRACTOR: Name Name: :�. ,r ; ,, Address: Com'pariy:i";e city: State7_7t. Address Zip Code: Fax: City: State: Phone NoZip Code: Fax: E-Mail: /'Yl '-pL,/ _ �eCc`'I�O L� C-0 -I 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. r 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 thepermit 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 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,consuIt with lender or an attorney before commencing work or recording our Notice of Commencement. Signatu e o 0 e /Lessee/Co tractor as Agent for Owner Signature of Contractor/License Holder STATE OF F ORIDA STATE OF FLORIDA COUNTY OF COUNTY OF Sworn to(or affirmed)and subscribed before me of Sworn to(or affirmed)and subscribed before me of Physical Presence or Online Notarization Physical Presence or Online Notarization this day of*6ciI , 20---)()by this day"of 20_ by C C)ltd d.I Name of perso I making statement. Name of person making statement. Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification, Type of Identification "Produced i Produced (Signature f otary Public-State of Florida (Signature of Notary Public-State of Florida) Commission No. AUDREY@SRtl"PHREY Commission No. (Seal) MY COMMISSION#GG 300817 3.1 EXPIRES:March 6"2023 of F Bonded Thru NolaryPubl Underwriters REVIEWS KUN I LUNINU IMMMM OR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW-. REVIEW DATE RECEIVED DATE COMPLETED ev.