HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: aS 0 202 ® Permit Number
MAY 1 i 2020
Building Permit Applica t'on
I i?-ti g I e.ioartnnient
Planning P and Development
Building 9 and Code Regulation Division St. Lucie Crounty, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PR• PdSED NpItOVEME T LtJCA iON:
Address: X-3 I( 04 V-Ce
Legal Description:
PropertyTax ID#: � � —(����" �(�� g, Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAiI.ED DE�S #t+IPT1Q fJF WOR+K:
ence epx q_61 59 , geeI - p
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CCf N STR U CTt O INFO R,1 NiATIUR
Additional work to be pertormed un er this permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping —Shutters' ' _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: 1,S,7-oD z•d:-. Sq. Ft. of First Floor:
Cost of Construction: $ 2_001f C> U Utilities: —Sewer —Septic Building Height:
a NFR NOW NIT;RAf OR:
Name C 1 6M n Name: -
Address: -6)()q s-e ( V Company:
City:7FpY �I'QrCP State: (r. Address: l.,cl,
Zip Code: i q �-7Z Fax: City: State:
Phone No.141— 26 4 —6 L/" �1-Z Zip Code: Fax:
E-Mail: 01ry)0�ICA OSo1ri o i 6 @)WG�1U0 .eom 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.
SU PLEMENTA CC3NSTFtUCTION LIEN. LA I�NF�R�MAT ON:
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 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
commencin ork or recording our Notice of Commencement.
Sig ature of Owner/Agent/Lessee/Contractor Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF lac,/'C' COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of J 206'by this day of 20_ by
i
(Name of person acknowledging) (Name of person acknowledging)
re of ary u lic-State of Floria) (Signature of Notary Public-State of Florida
(Signatu )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
mael—
Commission No. ;44` r" ;; AUDtVA)HUMPH7REY Commission No. (Seal)
MY COM ISSION#GG
;.�`.'
EXPIRES:March 6023
.2023
ru Notary blit Underwriters
REVIEWS FRONT ZONING PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
—R—ev-77/2-014