HomeMy WebLinkAboutBuilding Permit Application All APPLICA E INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��� ` a",D Permit Number:
RECEIVE®
Building Permit Application OCT 2 7 2020
Planning and Development Services
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
1"I1Vomb 1N0.9�EE''!•.{.'lMQ4tATI ,r':`' ia•}i '
Address:
Legal Description:
Property Tax ID#: Lot No.�
Site Plan Name: Block No.
4 wl,
Project Name:
Setbacks Front Back: Right Side: Left Side:
D "Al:l»EI •:D �RIPfi�I of v� ! 14 ..
t L
C
�o
.CO•NSTRUCT fV • ... ::ti^� .
i na worko e pe rme under is permit—c ec a a apply:
echanical ^ Gas Tank _ Gas Piping —Shutters _Windows/Doors
Electric _Plumbing ._Sprinklers _Generator Roof
Total 5q.Ft of Construction: _ _ Sq. Ft.of First Floor:
Cost of Construction;$�il� _ Utilities: —Sewer —septic Building Height:
:QWNER/LAS$ C4NTfA R `:
EE:
Name r--' Name:
M �
Addr Company:
City; Stater Add
Zip Code: Fax: City: sate:
Phone No Zip Code: Fax
l:-Mast: Phone N �-
--
Fill In fee simple Title Holder on next page(if different E-Mail
from the owner listed above) State o County License;. 4'
If value of construction is 2500 or more,a RECORDED Notice of Commencement Is regpired.
DESIGNER/ENGINEER; Not Applicable MORTGAGE COMPANY: Not Applicable
Name; Name:
Address: Address:
City: State: city: State:
Zip- Phone zip: Phone=
FEE SIMPLE TITLEHOLDER; _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 aermit 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH Y-011.11121ENDER-OWAR ATTORNEY BEFORE RECORDING YOUR NOTICLOF-COM MENCEMENT."
Signa riV1715w-ner/Lessee/Contractor as Agent for Owner Si&jVu-re of
STATE OF FLORIDA STATE OF FLORIRA
COUNTYOF COUNTYOF tp(2St►r Lu c1 e,
The fargoing instr ent was acknowledged before me The forgoing instrument was acknowledged before me
15 _,2 Pc�by
I 6to -, ( � -Y'. Gi�Q by thls4% _J�2
C�D�30 _�2day of_QC
an Ls Cu es in, Den-
Name of person making statement. Name of person making statement.
Personally Known IV/ OR Produced Identification Personally Known V,-' OR Produced Identification
Type of Identification 21tt Nota Type of Identification
Produced y public state of Roma
11--U Produced --Rwayy Public state of Flo&
My COMMIOU 325704 Christine Holland
Expires 04 W Comrflinlan GG 3NI04
Expires 0412212023
fftnature of Notary Public-State of Florida (Signature of Notary Public--STaTeCoTF 4oCi a
Commission No. C76 2)(;1�0-1 09 (seal) Commission No,65r�3ag_701L) (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
,COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev.2/7119