HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFOMUSTBE COMPLE. FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
rzCEIVFED
Building Permit Application
Planning and Development Services PEWITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Legal Description:
wroperty Ta 1-a
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Mechanical Gas Tank _ Gas Piping —Shutters
Electricg) Plumbing _ Sprinklers _ Generator
'FY�:t�.S9 St:cSw��-"T•at'EI
OFKa Sq.dyFt'D�of Construction: /ff0 giJel V80 XLai Sq. Ft. of First Floor: —
%6-Staaf Con'strffiion E**!c�:' Utilities: —Sewer —Septic
Lot No.
Block No.
Windows/Doors
X&n�,-Ritrc lk
Building Height:
Name�-_S�LR (L';Q. ' Name:
Address: foSOS' 7i Aso Q��-�S� �� Company:
City: �'� �i tyre e_ State: F Address:
LFill
de: 3 49S ) Fax: City: State:
No. Slx I 3�A- O 7. 9 y I Zip Code: Fax:
: jeT��o� Z +CQ.Re_)Iso A I , �F Phone No
fee simple Title Holder on next page ( if different E-Mail
fom to Owner listed above) State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUFP�.EMNTAI� Ga(USTRUCTaN�i�IENLAW INFQRMATlON. f76,
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: I Address:
City: State: City: State:
Zip: Phone Zip: Phone:
I
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: I Address:
City: I City:
Zip: Phone: I Zip: Phone:
I
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 such
prohibit
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 intendito obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
ignae o'fOw Lessee/Contractor as Agent
for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF %
COUNTY OF
The for oing instru t was acknowledge before
day by
ti
me
The forgoing instrument was acknowledged before me
this of 20
this day of 20_ by
(Name of per on acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- State of Florida) I
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identit ication
Personally Known OR Produced Identification
Type of Identific n
Type of Identification
Producedi_ �� I
Produced
ComisPs�� NIELSEN
Commission No. .•••;�a" °��.'''.. I
n # FF 115637
Commission No. (Seal)
'� *0 My Commission Expires
!•mina
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
i REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
j
WWII
RECEIVED
DATE
COMPLETED
I /
ev. /2014