HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ! D l�J� • �!J
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Building Permit Application
Planning and Development Services P n'"ng DePanment
Building and Code Regulation Division St. Lude County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: '/60/
Legal Description:
VENT;LOCATION
A F'f Vf
Property Tax ID #: 13o r -
(009. 010y• DCDy
Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front
Back: Right Side:
Left Side:
DETAILEDiDESCRIPTION
OF V1%ORK
V
i
CONSTRUCTIO�NINFORIVhATION'
Additions wor to ape orme under tis permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: 3300,26 (—*Px) Sq. Ft. of First Floor:
Cost of Construction: $ t5- 60 - Utilities: —Sewer _Septic Building Height:
.,OWNER/LESSEE'r, `
ti x °'' ,t ,F
CONTRACTOR
:s.
Name WAvije, A
Name:
Address: 0 /
Company:
City: e c,
State:
Address:
Zip Code: Fax:
City:
State:
1rilk/'//90
Phone No. /,2
Zip Code:
Fax:
E-Mail: rAIJ
allVeih�oN OnC 4Aw,,
cam
Phone No
Fill in fee simple Title Holde n 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.
SLIPJPLE;MENTAL CONSTRbC ION bE W, LAwi
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
FORMATION
-
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
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 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 our Notice of Commencement.
&WI 06064 �d
Signature o wner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF ui COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of FQ,6 , 20A by this day of , 20_ by
(Name of pe on acknowledging) (Name of person acknowledging)
(Signature of Notary Public- St a of Florida) (Signature of Notary Public- State of Florida
Personally Known OR Produced Identification' Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced T_L_ V3Produced
Commission No. (Seal) N;, 'AuRi-V, ''Commission No. (Seal)
of
Notary Public^ ,Ss pec 20.201
REVIEWS FRONT A � NGCOm c BRVsn. LANS VEGETATION SEA TURTLE MANGROVE
COUNT �'% , IE ^IE REVIE REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE _
COMPLETED 3 ro�h
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