HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONPAW
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ) 1�
Date: 2001g .p Permit Number: l V �� `J � 1 q
4w 'eVx .y 1 TI! i i > t,�ti14t4jAA A .r+ u oo ap i 49
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• i. 1 r� RECEIVED
Bl RYing Permit Application
Planning and Development Services MAY % 2018
Building and Code Regulation Division ST. Lucie County, Permittin,
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line pjp ","'II
Address: , -_*) V /
Legal Description: L4
Pr rty Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front 3 ' Back: ! `'42i0 Right Side: X 4 Left Side:
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Aaaitionai worK to De errormea unaer tnis permit — cnecK an apply:
11HVAC Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
❑ Electric ❑_ Plumbing Sprinklers ❑ Generator ❑ Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ / �j C/�o�• Utilities. _ Sewer LSeptic Building Height:
Name Name:
Addres(� Company:
City: State Address: D d
Zip Code:� Fax: City: .c>j�,f3 , 3�State:
Phone No. Zip Code: 'i��� Fax: 110
E-Mail: Phone No. 6 y-'— 71 IV
Fill in fee simple Title Holder on next page (if different E-Mail: V DU /v/i
from the Owner listed above) State or County License: ieide � 6d
1
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
t�51-31
DESIGNER/ENGINEER:
Name: _
Address:
City:
Zip:
Phone:
cable
FEE SIMPLE TITLE HOLDER:` I Not Applicable
Name: 1lJ
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY' Z n Not Applicable
Name: /
Address:
City:
Zip: Phone:
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 intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
_ Signature of Owner/ Lessee/Agent
re of Contractor/License Holder
STATE OF FLORIDA*,, 6� STATE OF FLORIDA
COUNTY OF COUNTY OF
The for ing instr ent wa acknowledge efore me
thix7day of 2 by
(Name of person acknowledging)
(Signature of Nota Publi - Stat ef
Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. ..Qv Pt,. Publid$�bf FlodPubliOeajbf Florida
Frances Donza
% w e g My Commission GG 092440
Revised 07/1
The for oing inst m nt was acknowledged fore me
this day o 20 `t�by
(Name of person acknowledge g )
(Signature of Notary ubli�/State of Florida
n v)
Personally Know'OR Produced Identification
Type of Identification Prii;lclucecl
Commission NO. i4Y��r Notary ps+race�otFlorida
iFrance onza
My Commission GG 09244o
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