HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
ALL APPLICABLE INFO MUST BE COMPLETED, FOR APPLICATION TO BE ACCEPTED
Date: 3� �a � SCANNED Permit Number:
St LuPie Coulft RECEIVED
Building Permit Applicatio
Planning and Development Services ST. Lucie County, Permitting
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial _
PERMIT APPLICATION FOR: �►es'OD�
Address:
Legal Description:
Residential k
Property Tax ID #: c9m -a3y- o002 Lot No.
Site Plan Name: Block No.
Project, Name:
Setbacks Front Back: Right Side: Left Side:
S1n z,, c00 P i t 0 "sd 11
11HVAC
❑ Electric ❑ Plumbing ❑ Sprinklers Roof pitch
Total Sq. Ft of Construction: I�SOO S . Ft. of First Floor:
Cost of Construction: $ r71 .100C) Utilities: Sewer Septic Building Height: 5 (
"Shutters
❑Generator
❑ Windows/Doors
Roof
R/LES�SE E:C®;NITRAC1T10;R:
Name 2.ecA SAAA AVN
Name:
Company:
Address:
Address: C) la�oX 1-G:-vim '
City: elc-- iru2 State: �PC
Zip Code: Zqa-132� Fax:
Phone No. 11 L— eko — i12.2Z
City: State:
Zip Code: Fax:
Phone No.
E-Mail:
State or County License:
E-Mail: CCSJ3V k �'.sA � Y o �So�,kh, NQ-7�-
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
`Y
S�l1PPLEMIENTAL CONS1"R� � CTI JN LIKEN LA�UU IN-F'®RIVl�►1-f®N'
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
City:
Zip: Phone:
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 inte btain financing, consult with lender or an attorney before
commenci ork or reqMcling yoLKNotice f Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
�—yc\�
STATE OF FLORIDA
COUNTYOFS')r.
COUNTY OF
The forgoing instrument was acknowledge before me
The forgoing instrument was acknowledged before me
this day of lvl c% { , 20 { by
this day of 20_ by
{a Sv�6V%-T-yr\
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
IE G1VEP1�
Signature of Notary Public- State of Florida )
(Signature of Notary P ,:� Flo MISS109#GG
16, Zg20
:*= �CPIRES: December
Commission No. go g�i�iN°tarypubL`Undeiwnto
mmission No. (Seal)
G ;oa:
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIE
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
/
COMPLETED
Rev. 8/2/17