HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: N'`
Pap �j,e10,1% OWED
Bui ding Permit Application my s 2019
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County.,_
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_
PERMIT APPLICATION FOR:
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PROPaSED li�ipROVEMEfVT L&ATICtN
Acid 5-1 C d t5 QBLIF- i LIJ
Legal Description:
Proper- - Tax I . #: 3 3 - G O 5 o) O d - Cn Lot No.
Site Plan Name: Block No.
Project Name:
i
Setbacks -ront. Back: ` - Right Sid,'e: L
_Mechanical _ Gas Tank _ Gas Piping —Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
:al"gSq�- f— CenMction: �1 6 n Sq. Ft. of First Floor:
-ftfof Fonstruotion: $ 15 3 l A '�"� . Utilities: -Sewer —Septic Building Height:
ame m G l= - 1 L� ; Name:
ddress: 5% y 6 e ,j ci C= S D(-N L C L (\ ( Company:
CI y: q T L v c\ E State: L Address:
Zi l Code: Ll :� -1 Fax: ) City: State:
P ne No. 0 o �- �:� � `1 `cc Zip Code: Fax:
E- ai : G-P.1 1 i- 1 Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or Cou y License
If value of construction is 2500 or more. a RECORDED Notice of Commencement is reauired.
SUPPLEItiIIENT tL CONSTRL CTIaN L{ LAil+�/3 iN �Rn /��rio�: a a °'
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DESIGNER/ENGINEER: Not Applicable
— MORTGAGE COMPANY: Not Applicable
Name: m
..
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
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 recoiloing your Notice& Commencement.
CM qLA
ignature of can, ssee/Contractor as g t or Owner
Signature of Contractor License Holder
STATE OF FLORIDA
' i Ju-"_
STATE OF FLORIDA
COUNTY OF -��"�
COUNTY OF
The forgoing instrume t was acknowledge before me
The forgoing instrument was acknowledged before me
this day of 20 by
this day of 20_ by
Csw
(Name of Wrson acknowledging)
(Name of person acknowledging)
ig ature of Notary Public- Stat8 of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identific o�ti'n
Personally Known OR Produced Identification
Type of Identification +
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Type of Identification
Produced ✓
Produced
Commission No. ,°os�`�""",,345eLASHAHNAINGRAPI
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