HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll AP �LICABLE INFO MUST BE WORMED FOR APPLICATION TO BE ACCEPTED
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Building Permit App ication��`7
Plann�gand Development Services
Permitting Department
euildii � and Code Regulation Division
St. Lucie �,f,�lai'i
y, FL
2300 I'llirginia Avenue, Fort Pierce FL 34982
Phon I: (772) 462-1553 Fax: (772) 462-1578 Commercial
Residential
PER
IT APPLICATION FOR:
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PROPQSEa
!NP FOU'ENA, ANT l.C3C l� .
AddresII:
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Legal DII
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scription:
1I
Prope r,
Tax ID #: Q /"
ID I) Le— OO S -7` 00 —
1 Lot No.
Site Pla
Name:
Block
No.
ProjectlName:
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SetbaMks
Front Back:
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Right Side: Left Side:
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D TAILED DE�SRI'PT lDN C1F 1tVa
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C * TR CTItJN 1N:FOR� AT'ION: t
Additi i;�naI work to, be pertormed under,,t is permit, check all. tat apply:
CP�/Iechanical _ Gas Tank ' _ Gas Piping _ Shutters Windows/Doors
_ ectric C—Plumbing _ Sprinklers _ Generator woofs —Pitch
Total SI . Ft of Construction: AE 6 Sq. Ft. of First Floor: C �
�
Cost of I F ionstruction: $ .'_', � �,: U U Utilities: _Sewer _Septic ` 'Building+jeight: /
Nam I'll 10 /� Name:
Addr ss: /���' Company:_
I
City: State Address:
Zip C�I de: Fax: City: GG
PhonI No. `' b 6 Zip Code:
i
E-Maid AA/Al oC2A .44 Phone No
Fill in1111 1lee simple Title Holder on next page (if different E-Mail
from ,,he Owner listed above) State or Cou
Stater
Fax:
In
cense
If value ibf construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER ENGINEER: Not Applicable
1.a, ',W00 N ORe GAGE COMPANY: _ Not Applicable
Name: 1 1
Address: o / Address:
Cit P State: V City: Y State:
Zip: Phone 77 — ' V--73,;V 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 inspe ion. If you intend to obtain financing, consult with lender or an attorney before
commencin r ecordin our Notic- .p oinmencement.
:_ Signature of wner/ Lessee/Contractor as Age for'bwn .
Signature of ntractor/License Holder
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STATE FLORIDA�o
COUN a m
STATE F FLORIDA
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OF, C'°
COU OF
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The forgoing ins ent was acknowledge of Sri
The for oing ins t was a' cknowledged_befor
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r�Et M
this day o 20)by ANNT
this day of 20 M-bi
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Name of person 6naking statement.
Name of person making statement. 19,
Personally KnoWw� OR Produced Identification
Personally Known .1� OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
i�
(Signature of No ry Public- State of Florida
(Signature of 616tary Public- State of Florida)
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
ANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
RE I W
REVIEW:
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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