HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED
Date:
TIION TO BE ACCEPTED
Permit Number:
SCANNED
Bly
Bui9countv
ing Permit Application RFCFt vFp
Planning and Development Services NP
Building and Code Regulation Division Penn. �'®
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2300 Virginia Avenue, Fort Pierce FL 34982-
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select friom dropbox, click arrow at the end of line
,PR 1 0 . P I OSED, . IMPROVEMENT,WcAmWt •.'
Address: tJ I �C3�� �� n rAm C ` "tL
Legal Description: Izez1
Property Tax ID #:��
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side:
Left Side:
Lot No.
Block No.
6
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CONSTRUCTION INFORMATION. E
Additional work to be Dertormed under this permit -check all apply:
11HVAC LJ Gas Tank ❑Gast Piping _ Shutters Q Windows/Doors
11 Electric 0 Plumbing E]Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ ��� ®� UtilitiesSewer Septic Building Height:
.. : ..:. �
-OWNER/LESSEE:'. ..�
,
.CONTRACTOR:.
Name
Name: M
Company: ClC3c_-)�
88
Address: 1�
City: State:
Zip Code: .�1 � Fax:
Phone No. J / V � I
Addres
City: A"k'� C � \--1 State: L
Zip Code: Fax: 19 rl• )- g bc�b
one No. h fi %"b0710
E-Mail: &-I—i 05 ;I ff W• 0
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: Q P o)� SA-L-�e-t -4-
State or County License: Q. P Cd 01 � le
Iif value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL',CQNSTRUCTION:LIEN LAWIN.FORMATIO.N
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 piior 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.
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Signature wner esse tractor as A for Owner
Signature f Contracto License Holder
STATE OF FLORIDA
COUNTY OF r 0 �� Q�t'">
STATE 0
OF F
COUNTY OF(�1�
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The f .55��oing instrument was acknowledged before me
this 3`�ay of 20�rby
The r oing instr me t a Rnowledg�efore me
this day of 20_ by
Name of person mak' . g statement
Personally Known OR Produced Identification
Name of person making statement /
Personally Known OR Produced Identification
Type of Identification
Produced
Typ of Iden ificatio
Pr d ced w�1 CQi1�
igna ure of N I' -
-WN*
(Signature of Notary ub '
r PV Notary Public State of Florida
Commission No �tk la SmitHSeal)
My commission FF 191205
�OP qb Expires 0212312019
.'" •.• SUSAN JAWORSKI
Commission No. R `. Not(gfdj�-State of Florida
- ' » ' Commission 4 GG 094114
;yt r ro�� My Comm. Expires Apr 13, 2021
Bonded through National Notary Assn.
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Rev. 8/2/17