HomeMy WebLinkAboutBLDG PERMIT APPLICATION, NEEDS UPDATINGAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
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:
RR 3I t ED tNPR t ME 1 ' L CATK M .
Address: s e�
Legal Description:
Property Tax ID #:--�// - "' CS L1 - Lot No._�_
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
flViERSE
LES
ON
Name S71Sat'7
Name: v'q el
4'
Address: !� .
Companr�/Er,-}yr,�l,�, i�
City: State:/_
Zip Code: f Ky f -9-- Fax:
Phone No. 77j - (v - -�
Address: 4?Q_ :r °V/-;4 .
City: a . P t�
Zip Code: .5 y95-2 Fax:
Phone No `
E-Mail ri7
State or County License " DS- eo
E-Mail: ��'- /p
Fill in flee simple Title Holder on next page ( if different
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRl1CT10N'1,1EN LAW iN1=QRMATION:�
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable.
Name:
BONDING COMPANY: ,Not Applicable
Name:
Address:'
City:
Address:
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 IMPROYEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDER ARID
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION, IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/ Lessee/Contractor a�,9&;ntfor Owner
STATE OF FLORIDA )
COUNTY OF �4. 1 t) L1 P.
The forgoing ins trtt ent was acknowledged before me
this ? L day of _ i b" 20a�) by
'•tit s(i —Rbm� —yi
Name of person mak�ement_
Personally Known OR Produced Identification
Type of Identification t
Produced
{Signature of Notary Public- St
oolty Notary Public State a Flom
d {{ t =a `�{fSsa L Butterfield
Commission No. ./1t�" S ommiulort GG 302065
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ar r:
REVIEWS
RECEIVED
DATE
COMPLET
Signature of Contractor/License Holder f
STATE OF FLORIDA�-)
COUNTY OF � - �tfU
The forgoing instr4frient was acknowledged before me
this dayof f'it� tom_, 20 l by
it ,064 -T6 6-n' }
Name of person making statement_
Personally Known OR Produced Identification
Type of Identification
re of Notary Pubf'ic- State of
;ion No.i
`}0JYr„Yo� .OtanPib.c S!ve
,Weissa L Bu'te:fiel
tSGnMv iA^z E,-,'•es ?2t;-t2023
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