HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:.
SCANNED
BY RECEIVED
St Lucie County
Building Permit Applic tiorJAN 31201$
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 �01
11
Phone: (772) 462-1553 Fax: (772) 462-1578. Commercial Residential -
PERMIT APPLICATION FOR: )V
Address
Legal Description:
Property Tax ID #: �� (� ���-- 0ol —1 "" Lot No. r
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
N
amonai worK to tie perrormea unaer tnis permit— cnec
_Mechanical _ Gas Tank —Gas Piping
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: 1 :3 26
Cost of Construction: $ (2000
aii tnat apply:
_ Shutters _ Windows/Doors
Generator Roof Pitch
Sq. Ft. of First Floor: t 3
Utilities: —Sewer —Septic Building Height:
OWN �R/L080S
CQN RACT4R:
Name �) L i=�' C.L'grn:
Name: ry-?cf Oc-,�nc
Company:
Address:
Address: 9? i4 (3c,� M> C L G. n e
City: Q> r � r1-' �_ State: _
Zip Code:.?4 9 5 Q Fax:
City: State:
Phone No. —(:� `J-- 6Cj C`i
Zip Code: Fax:
"one No
E-Mail: �I a �� lG t G% �� 7c� Gs�c,��
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Sl1PPLEME iAL GtJN 1 RU
TIaN LIIE
A�Tt
DESIGNER ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name: " ....
Address:
I
Address:
City:
I State:
City:. State:
Zip: Phone
I
I
Zip:' " "_ Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
I
City:
City:
I
Zip: Phone:
Zip: Phone: I
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 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 requlested 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 Ngtite of Commencement.
i
Sig e,of essee/Contractor as Agent for Owner
Signature of. Contractor/License Holder
STATE OFF ORIDA
STATE,OF FLORIDA
COUNTY OF S:: tv ����
COUNTY OF
I
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
thigzb day of 20� by
this day of 20_ by
sN- NA-r
Name of person making statement. I
Name of person making statement.
Personally Known, __ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
I
Type of Identification
Produced �1' L
Produced
(Signature of Notary Pb�,�tt rNN��A
(Signature of.Notary Public- State.of FloridaY
oMIEGNEMS
Commission No. �pvcgM€�I 10 #k GG 022023
), 2020
(Seal)
Commission No. Seal
Es: 25�s
BondedhNtJotaNpubl10uPdenvriters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
!
DATE
COMPLETED
3 Z
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