HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INF UST BE COMKETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: -
-,
Building Permit Application MAY 2 0 .J20
Planning and Development Services [ST. Lucie County ermitting
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 S
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PROPO- D � P� O E E T OCA • N:
Addres
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks ' Front Back: Right Side: Left Side:
D AILED DESS+RIPTION OF WOR :
(,v C_�
u lde r
CON RUCTLO INFORMAT ON:
Additional work to be pertormed under this permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator. _Roof
Total Sq. Ft of Constructi : Sq. Ft. of First Floor:
Cost of Construction: $ 3 Utilities: —Sewer _Septic Building Height:
OWN,1E;/LESSEE: •ONTRACTOR:
Name <C-% � Name, A d++� /�
2
Addr ss: -74)a �e-�/►20-�i /� Company'.: i.' ►T (� r''�C
City: Tt E4'CG State: Address:
Zip •ode: 3`F�' � Fax: City: _ — State:
Pho No. -7 2 7- —(rte'? ' C� Zip Code: S
E-M 'l: i21C,//�l/Zh /Y) !� i t/G'c��`� Phon o. 2.
Fill in ee 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.
SUP EMENTA CONS R CTION LI NF7me:
DESIGNER/ENGINEER: _Not Applicable GE COMPANY: _ Not Applicable
Name:
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
commencing work or recording our Notice of Commencement.
k_ XK1�!'
Si nat re�6f Owner/Agent/Lessee/Contractor Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S LJ COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisZwb day of 20da by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pubq--State of Florida) (Signature of Notary Public-State of Florida)
Personally Known R Produced-ldentificatiori Personally Known OR Produced Identification
Type of Identification P du + ... 3. Type of Identification Produced
WS.••••••-. MY COMMISSION#GG022023
Commission No.�a ' —
�; EXP�BE�Il�ecemi�eP16,2020 Commission No.
d e.••' Bonded Thm Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW - REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2-014