HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c�
Date: `a � �� Permit Number: M C `' 6,
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Building Permit Application SEP 9
Planning and Development Services
Building and Code Regulation Division _ ST. Lucie County png
ermitti 2300 Virginia Avenue, Fort Pierce FL 34982 t
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential 1''
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of li-
PROPOSED IMPROVEMENT LOCATION ?
Address: _`VA�
Property Tax ID #: L\Sbo1 - �jb\�D�"3�l 01�0�� Lot No�-
Site Plan Name: 2r�_e,S-Stases Block No.
Project Name:
Setbacks Front0 Back:_ Right Side:, Left Side:_
,DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
ition work to be nerformed under tispermit-check all tha apply:
HVAC
I-_1 Gas Tank
Gas Piping
_
Shutters
Q Windows/Doors
[
lectric
L-Plumbing
Sprinklers
1:1
Generator
E]
Roof
Roof pitch
Total Sq. Ft of Construction:
Cost of Construction:'$
S Ft, of First Floor:
UtilitiesInSewer 0Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
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Name `
Name: Rzz�ZEc`.��
Address: V.
Company: -,,L-YvNO GCSr.�
City: State:YL -
Address: Dcks�,
a Z�a,��
Zip Code: Fax:
City: `C �� ����. State
Phone No.
Zip Code:Fax:
E-Mail:
Phone No.
Fill in fee simple Title Holder on next page ( if different
E-Mail: w�SJrf<'.C`�r�naiS�i�.C. czC." eAS •..�'t
from the Owner listed above)
State or County License:
If value of construction is $2500 or more,.a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGIN
Name'
Address:
City:
Zip:
_ Not Applicable
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 Coun 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 vour Notice of Commencement.
& _141a
Signature of wner/ Lessee ractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Za� Lives. L COUNTY OF nk -Q_
The forgoing instrument was acknowledged before me
this —L.�_ day of 20 \I* -
Name of person mak' tatement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of
Commission No.
REVIEWS
RECEIVED
COMPLETED
Rev. 8/2/17
FRONT I ZONING
COUNTER REVIEW
The forgoing instrument was acknowledged before me
this day of 26�_'% by
Name of person making statement
Personally Known 2�jOR Prod c IS
ntlfirt[ap
Type of Identification STELLA M. HUNTER
STELLA M HUNT
Notary Public - fate o'I
Commission I(Si�$Notary
My Comm. Expir s Jan
Bonded through Na o
Nntafy Public - State of Florida
Commission # FF 180552
My Comm. Expires Jan 23, 2019
Bonded through National Notary Assn.
(Seal)
SUPERVISOR I PLANS I VEGETATION I SEATURTLE I MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW