HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE C '= ` ° _'PLETED FOR APPLICATION TO BE ACCEF i
Date: `T - a� - a t�\ �'S Permit Number:
scANNE®
BY
St Lucie Q0Unty
' APR 2 7
Building! Permit A licati ?0�8
g p p �ittlp9 D
Planning and Development Services Sr Lucie Cou��,ent
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
Property Tax ID #:
Site Plan Name:
Project Name: -
Setbacks Front a
KOJGK • w
Back: �_ Right Sidei: Left Side:
_Mechanical _ Gas Tank —Gas Pipi , g
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $: , 6 -
Lot No.
Block No.
.Shutters Windows/Doors
Generator —Roof Pitch
Sq..Ft. of First Floor:
utilities: _ Sewer _ Septic Building Height: /3
®WN'ER/LESSEE:
CONl"RAGi'(JR
Name Q, �S� i
Name:
Address: a77 Lu L t�j
Company:
City: State:
Zip Code: Fax:
Phone No. -7?),33-1- 133 Z
E-Mail: a,Q'; 1 ® Yea.:` •cc,
Address:
City: State:
Zip Code: Fax:
Phone No
Fill in fee simple Title Holder on next page( if different '
i
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
i
601 �01` I
�UPRL ME T L Ct7NSTR. CTIQ LIEN LAW 011
DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY: ..
— Not Applicable
Name:
Name:
.. .. .. __ .
Address:
Address:
City:
State:
City:
State:
Zip: - Phone
Zip: Phone:
FEE SIMPLE>TITLE'ROLDER:
Not Applicable
BONDING COMPANY:
Not 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.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder td 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
commencingwork or recordingour Notice of Commencement.
ev.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder '
I
STATE OF FLORI�~
STATE OF FLORIDA
COUNTY OF
�
COUNTY OF
The fo oing instru ent was acknowledged befo
�e
The forgoing instrument was acknowledged before me
this day of 20� by R x� �
this day of . 20_ by
Vi
J�°1 _
2