HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE IiNFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED d
Date: Z � � SCANNEDPermit Number:
..- �.-- -, �Y FRECIVED
• _ St Lucie County
Building Permit Application22Planning and Development ServicesBuilding and Code Regulation Division —FTittng
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residentia
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line e,n4tc,�d ,
PROPOSED IMPROVEMENT LOCATION:
Address: �5-60 1 �` � Cu r-eS ) 1 14 14 Legal Description: C)+ 40 OP SE7 l O�- I LO o` <�� 1 `
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Property Tax ID #: 1,10-1- 4�2- bc)40 - coo- - Lot No.
Site Plan Name: rryyerr 3 ^! Block No.
Project Name: Q0��0�/
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Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORk:
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'CONSTRUCTION INFORMATION:,
-A-dUitional workto be nerformed
0HVAC Gas Tank
under this permit- check
Gas Piping
a
apply:
S ters
Windows/Doors
_
Electric ❑ Plumbing
❑Sp rinklers ,
LLd"Generator
Roof Roof pitch
Total Sq. Ft of Construction:
S . Ft. of First Floor:
Cost of Construction: $ -
Utilities:
Sewer[]Septic
:. Building•Height:
OWNER/LESSEE:
CONTRACTOR:
Name kp(J-wYnwaveyanName:
Address: i
Company:
City: tate: �__L
Zip Code: ( Fa �� �`
Phone N 1
Address: b
City: I- State:
Zip Code:
Phone N . n
E-mail: a nn I la(
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Fill in fe simple Title Holder on next page ( if differe
from the Owner listed above)
E-Mail:
Yl (
State ounty License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
'SUPPLEMENTAL CONSTRUCTIO'N PEN' LAW INFORMATION:
DESIGNER/ENGINEER: I _ 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: I
Address:
City: I
City:
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 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 appliclations 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.
IOle
Signature of 0 ner/ Le ee/Contractor as Agent for Owner
Signature o C ntractor/License Holder
STATE OF FLORIDA
COUNTY OF 1=1L�I
STATE OF FLORID I� 1 �t`e -�
COUNTY OF I ,L I v
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Name of p rs n making statement
Personally Known OR Produced Identification
Name of ers n making statement
Personally Known OR Produced Identification
Type of Identification I
Type of Identification.
Produce
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Ex ' s October , 2021
ature of Notary blic-St of rida)
(Si to o otary Public- Stat of Floridaission
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0mmNo. (Seal)
Commissio (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
I
DATE
COMPLETED
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Rev. 8/2/17