HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST
BE COMPLETED FOR APPLICATION TO BE'ACCEPTED
Date: _ Lo• —9. Permit Number: —
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BY
• St. ,Lucie Count EIVED --
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Building. Permit Appli.cati I
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PlannijandDevelopmenfServices2 9 CuBuilding
and Code Regulation Division unty Perrnictiny
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2300 Vir inia Avenue, Fort Pierce FL 34982
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Phone:. �772) 462-1553 Fax:'(772) 462-1578 -Commercial Residential
PERMIT APPLICATION FOR: I
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Address: 01.
Legal Description:
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Property T xID#: A1—�.31—�C��— o(OLA` �e)-�� Lot No.
Site Plan Name: Block No.
Project Na e:
Setbacks Front Back: Right Side: Left Side:
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A ttiona wor to e performedun er t is permit — c ec a tat app y:
_Mechanical _Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
—Elect is _ Plumbing _ Sprinklers — Generator Roof Pitch
Total Sq. Ft of Construction:_) IWO Sq. Ft. of First Floor:
Cost of Construction: $ �0l00 Utilities: _ Sewer _Septic Building Height:
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Name
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Address:Company: (
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Cit State: i � Address:
Zip Code:. Fax: City: _ �i� r(,'e (_
State:Zip
Phone No � — Code: �g9,50 Fax: ;
E-Mail:' Phone No
Fill in fee imple Title Holder on next page ( if different E-Mail I _e' cQ (`
from the 8wrier listed above) State or County License C Q f
I
f value of co
istruction is 2500 or more, a RECORDED Notice of Commencement is required.
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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:
i Name:
Address:
i i Address:
City
I Zip: Phone:
j
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 accorc(ance 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.,
j
Si attire of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
jSTATE ;OF FLORIDA
STATE OF FLORIDA It
I
COUNTY OF (�,
COUNTY OF nlF
The for' ing instrument was acknowledge before me
this�day of , Ot, 20j& by.
i
i The for ing instru ent was acknowledge'$before me
thispWday of 20� by
(Name of person acknowledging)
(,
(Name of person acknowledging )
i (Signature of Notary Public -,State of Florida)
(Signature of Notary Public- State of Florida)
Personally Known OR Produced Identification
Personally Known OR Produced Identification ✓
Type of Identifica In
Type of Identificatio
Produced
Produced
`�OSPRY PLB%% KAREZl�d
Lon Stat ENi
No. _• _@�ommission
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