HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONA
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Inla-
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Building Permit Application DEC �7
Planning and Development Services
Building and Code Regulation Division PEIVI,
2300 Virginia Avenue, Fort Pierce FL 34982 St. Luck
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: .§`&V N 911( 5 r (1 am G h a P i dC -�
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Legal Description: SYy A des- /b G � �� Seel !� arc -�� �P
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Property Tax ID #: el.051 "Sol' ? Of 0a0 f 0 Lot No. Csy
Site Plan Name:"'* Block No.
Project Name:erw
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Setbacks Front Back: Right Side:Left Side:
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Gas Tank
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apply:
Shutters
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Electric
❑
Plumbing
[]Sprinklers
❑
Generator
❑
Roof
Roof pitch
Total Sq. Ft of Constructions S Ft. of First Floor:
Cost of Construction: $ Ji 000, eo Utilities: Sewer []Septic Building Height:
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Name: SQIn4?_
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City: %CI Y GAoi e , State:—
Address:
City: State:
Zip Code: a 33 Fax: 09 &_
Phone No. V—'MV
Zip Code: Fax:
Phone No.
E-Mail: O
Fill in fee simple Title Holder on next page ( if different
E-Mail:
from the Owner listed above)
State or County License:
IIIf value of construction is $2500 or more, a RECORDED Notice of Commencement is required. �I
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'A' *FORMATION: �N�j
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
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 your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The forgoing instru ent was acknowledged before me
this l( day of ZO - by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Producedv_'A L.._
ature of
Commission No. p
FF40` ?'Iy Co �Xsion r rr 7 �0
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Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of , 20_ by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
on
ma mrough Nation
I Notar YW5.As
REVIEWS
FRONT
ZZ�`SlJ
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17