HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONT
All APPLICABLE INFO M ST BE COMPLETED rvii APPLICATION TO BE ACCEPTED ,y ,
Date: Permit Number: \ l A0 1— (Z 5
SCANNED
.=$ BY EREIVED
St Lucie County..12018
Building Permit- ApplicPlanning and DevelopmeritServices ty, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort -Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
Property Tax ID #: (� (o[ ! �O `� Lot No._
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
T _
Additional work to be pertormed under this permit — c ec a t at app y:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator oof '�` n + �Pitch
Total Sq. Ft of Construction: 1 0J Sq. Ft. of First Floor: /
Cost of Construction: $ 0 -0® Utilities: _ Sewer — Septic Building Height: r
Name kc Name: --A 40
Address: _5__ c,"t C-A'n Company:
City: i'9 o State: _ ddress:
r Zip Codei Fax: City: ( L State:
Phone No. j A_5 1® 4 3!3 Zip Code: � Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail Jolwk le
from the Owner listed above) State or County License �"C�92&7Q % -
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
1)
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 I BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
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 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 1 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 our Notice of Commencement.
Sign6ture ner Lessee/Contr or s Agent for Owner
Signature of Contr ctor/License Holder
STATE OF FLORIDA J
STATE OF FLORIDA
COUNTY OF � � ILL
COUNTY OF TAl �J 4
The forgoing instrument was acknowledged before me
this day 20 by
The for of g instr- ent was acknowledgefore me
20T by
of T+ ,
thisay of
(Name of p so ackn wledging
t
(Name of perso acknowledging )
(Signature of Nory Public- tate of FI rida )
(Signature of Notary Public- State of Florida)
Personal) Known �/ OR Prod ed Ide tification
Personal) Known (/ OR Produced Identification
Type of Identification tephen �. Frederick
e NOTARY PUBLIC
Type of Identification tARY Stephen P. Frederick
Produced c
OF FLORIDA
Produced Y PUBLIC
CornrE
Commission No. it Expirtes/27
= STATE F F ORIDA
Commission No. l C0MrJ�
021
ip E19�� Expires 1/27/2021
REVIEWS
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ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
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