HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
1.
Date: Permit Number:
SCAN NED
MOM
MAR SO' 201
Building Permit Application
Planning and Development Services Permitting Department
St. Lucie County
Building and Code Regulation Division
2300 Ifirginia Avenue, Fort Pierce FL 34982
PERMIT PPLICATION FOR: To Select from dropbox, click arrow at the end of line
Legal Description:
AJ
PropertyTaxlD#: Lot No.
Site Plan Name: cwbMiql rx�h)p- M6�,te kn^e KhrJ& Block No.
Project Name: I
Setbacks Front_10 Back: I !L Right Side: Left Side:
DETAILED DESCRIPTION.'OF- WORK:
Sive wide,, horne-
CONSTRUCTION INFORMATION'
Additional worK to be performed - under this perm t c ec a apply:
1]HVAC Gas Tank Piping'� Shutters FlWindows/Doors
as
Electric Plumbing [:]Sprinklers', E]Generator Roof Roof'pitch
Total Sq. R of Construction: S . Ft. f First Floor: 16919
1) U P)
Cost of Construction: $ zsm 6 Utilities: Sewer Septic Building Height-
S
-CONTRACTOR:
Fill In fee simple Title Holder on next page ( If different
�,E-Mall: )ILn )-a us V9 0)6mc�,I- com
from the Owner listed above)
State or County License: .3 t 6-3 c3
If value of construction is $25W or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN: LAIN INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: JL Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone IZip:
i
Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: xNot Applicable
Name:
Name:
Address:
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.
I
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 Associatioh 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
commencine work or recordine vour Nntice of Cnmrrtenrement_
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA .
STATE OF FLORIDA
COUNTY OF L)3 y�
COUNTY OF Q
The f,going instrument was acknowledged before me
this day &
The for oing instrument was acknowledged before me
T
of J111n 0 1 .2011 by
this day of _MCA Ird) . 20JX by
Aaron au i �
Name of person making statement
Name of king statement
pe on ma—
Personally Known XOR Produced Identification
Personally Known � OR Produced Identification
Type of Identification
Type of Identification
Produced P is (1 isMsh:fl
Produced I kit Kificlio
(Signature of Notary Pu ' - State o lorida)
(Signature o Notary Publi - to of Flori )
Commission No.
Commission No.
Notary Public State of Florida
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DATE
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DATE
COMPLETED
Rev. 8/2/17