HomeMy WebLinkAboutBUILDING PERMIT APPLICATION,L APPLICABLE FO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
)ate: SCAN N Permit Number: ilrba1- 0aw _
BY
Building Permit Applicatio JUG i ® ' 098
i Planning and Development Services
Building and Code Regulation Division S7. Lucie County, Permi g
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
J'I�ERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line s
aPROPOSED IMPROYZMENT LOCAT4M.
Description`±
Property Tax ID #:
Site Plan Name: b
Project Name: 0r
Setbacks Front /04 1 Back:
i O _M i/RIO/ N,
/1
F,Right'side: Le Side:
Lot No.
Block No.
,I'DETAILED DESCRIPTION OF WORK:
� n5atter S Si etic
t'hg- a2W 0 **i 11V
COWrRUCTIOWINFORMATION:
Lr,IH C LJG�asTank
Electric ff Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Jer rnIL — Lf MLIN all dPJJly:
3as Piping 1:1_ Shutters Windows/Doors
Sprinklers FIGenerator Roof Roof pitch
Sq. of First Floor:
J Utilities: [] Sewer _ Septic Building Height:
OWNER/tom,
CONTRA OR:
Name 11'1
Name:
Address:
Company:
City: d State: _
Address: 0`
Zip C de: 24Q,3 Fax:
City:
Phone No. ''
Zip Code: Fax:
E-Mail: .
Phone No. —
Fill in fee simple Title Holder on next.page (if different
E-Mail:
from the O n r listed above)
State or County License:
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
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11PPLEMENTAL
CONSTRl1CTl'ON
LIEN LAW INFORMATION
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aESMOMPENGINSE""Not
Applicable
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ANY:
plic bo
Name: �
f3
Na—O
Ad
Ad/City:
State:
Cit
State:
Zip:
Phone
— —
Zip
ne:
— —
FEE SIMPLER:
Not Applicable
BONDING CO
P Y:
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 Co entYf c ePtt ust be recorded and posted on the jobsite
before the -first insp tion,�lf you intend too ain financing, con It wit�i lender or an attorney before
corDrK ncing work or c9Jrding your Notice of Commencement.
Signature of Owner/ Lessee/Con or as Agent fo caner
S' a o Contractor/License Holder
STATE OF FLO�tIDA
S� Lv �.�
STATE OF FLORID
OF S tie
COUNTY OF _
COUNTY
The forgoing instrument was acknowledge cLbefore me
``
The forgoing instrument was acknowledged before me
\ o 5 J \%t
thisLd day of Z50 I 201 by
this day of 20:�-k by
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced �i✓L D �—
(Signature of Notary blic- State of Florida)
(Signature of Notary.Publl,c=-`§fate Of F.Ie(� 9p �IEGIVENS t
Commission No. J0E`ES%N41 (Seal) s
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MY COMMISSION # GG 022023 b,
Co mission No. ` � �R` 96,2020
EXPIRES: de l
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PLANS
VEGETATION
SEA TURTLE
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COUNTER
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REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
I `I I
DATE
COMPLETED
tev.8/2/17