HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: Nos-- owrL
SCANNED
iLZF��J BY
St Lucie Coulity RECEIVED
Building Permit Application
Planning and Development Services MAY U 7 2MO
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 i Permitting De ment
st. uc' ounty
Phone: (772) 462-1553 Fax:�(772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Seleict from dropbox, click arrow at the end of line
PROPOSED IMPRO� VEMENT LOCATION':
Address: ,I E
Legal Description: IA` 4� T"� L✓crr L
Property Tax ID #: � 14-0 _�51 5_�O Z ' i A�b "
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Additional work to be ertormed under this permit- check all apply:
❑HVAC 1. Gas Tank ❑Gas Piping _ Shutters
❑ Electric ❑ Plumbing ❑Sprinklers []Generator
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction- $ �Q ` Utilities: Sewer ❑ Septic
Lot No.
Block No.
QWin ws/Doors
Roof oof pitch
Building Height:
OWNERJLESSEE:�'
CONTRACTOR
Name
Name:
Company:
Address: 'S (� > _.
City:State: _
Zip Code: Fax:
Address: O - `—
City: �l`C State:
Phone No.
Zip Cod_0LC) Fax:
E-Mail
Phone No.
Fill in fee simple Title Holder on next page (if different
E-Mail: I✓1,��-� Gj ��G
from the Owner listed above)
State or County License: Q _._Cr_, L32_6d �`E
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
VC
S,UPPLE.MENTAI,
CONSTRUCTION LIEN. LAUV INP4RMATION�
Y
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ 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 to build the subject structure
is in Home Owners Association bylaws
which conflict with any applicable 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 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.
x
Signature of ner/ Lessee/Contractor s Agent for Owner
Signature of Cb-i4tractor/Licehse Holder
STATE OF FLORIDA
COUNTY OF
STATE OF FLORID
COUNTY OF 1_u
,a
s
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this � day of 20� by
this �i day of MQ, 20_a by
Nam_ Qof person ma ing statement
Name of rson maki g statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(SigMdurlrof Notary Public- State f Florida)
(Signs ure of Notary Public-,Stat0of Florida )
��°�� yea►. �,
Commission No. (H��1AHNA INGRAM
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Commission No. .`,PRYPom�,, ($eal!)ASHAHNA INGRAM
.= Notary Public - State of Florida
,° a �; Notary Public -
¢ State of FI
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My Comm. Expires Dec 20, 2018
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DATE
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DATE
COMPLETED
Rev. 8/2/17