HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: i �'O Permit Number:['��
Planning and Development Services
Building and Code Regulation Division •
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2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 46i' 1578
PERMIT APPLICATION FOR:
Address: UI
Legal Description:
Bull
Property Tax ID#: 1775�0-2— �Q U
Site Plan Name:
Project Name:
Setbacks Front Back: Right
Total Sq. Ft of Construction:
Cost of Construction. $ S5,001
GGAN ED) RECEIVED
�;� rprr it Application MAR 151018
mmercial
Permitting Department
St. Lucie County
Residential
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Left Side:
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
r
Lot No.
Block No.
0
Building Height:
ti)WNE1%1]REP N E: N
CONI I RNNIE,
Name
-Name'.=
Address: y
Company':_
City: � ?j i fcf— State: F!,::L
Address: 'i
i Zip Code: 34qZ- Fax:
City: ° .. i State:
Phone No Z—jry Z-3
Zip Code:, ,{ Fax:
Phone No -,..
E-Mail'
E-Mail: bnAa
Fill in fee simple Title Holder on next page ( if different
State or County License
from the Owner listed above)
If value of construction is 2500 or more,'a RECORDED Notice of Commencement_ is required.
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S 1411E All-
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
-Name:
Address: I
Address:
City: State:
City: State:
Zip: Phone =;
Zip: Phone:
I
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name:'. I Name:
Address: I Address:
City: City:
Zip: Phone: I Zip: Phone:
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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 structures,
is in Home bylaws
which conflict with any applicable Owners Association rules, 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 `r`esult in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inMection. If you intend to obtain financing, consult with lender or an attorney before
co mpncing work r recording our Otice of Commencement.
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S'ryyure of Ow / Lessee/Contractor as Agent
for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S+ LuC_Ze
COUNTY OF
The for.gPing instrument was acknowledged
before me
The forgoing instrument was acknowledged before me
this day of 1721;bf 4-4 201,�J
by
this day of 20_ by
(Name of pe son acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- Stat f Florida)
(Signature of Notary Public- State of Florida)
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
L
Type of Identification
Produced
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Produced
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Commission No. (Seal
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Commission No. (Seal) .
REVIEWS
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PLAN
VEGETATION
SEATURTLE
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REVIEW
REVIEW
REVIEW
DATE
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