HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED , o
Datll SOANNED Permit Number:
permitting
BuildingPermit Application St. Lucie countY
Plan' ing and Development Services
Buil �ng and Code Regulation Division
230� Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial _� Residential
PER
",IIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PRO
x
E OSED iN1RROVEMENT
.
1.t1,CATIt3N s
x
AddrQ s: `CD(-CL���
Legal escription:
Prop �{ y Tax ID #: Q\ACn - �3a- <ZXDZ::- O - �J Lot No.
Site P an Name: Block No.
Proje Ili Name:
Setbacks Front Back: Right Side: Left Side:
-Eas�c
sicd
CND TRUCTION INFORMATIQ.IV a �{
a Y
it4ona workto e e orme urider this permit - c ec a apply:
—,
HVAC Gas Tank Gas Piping Shutters ID-Windows/Doors
tElectric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total cl Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ ��Lo�1 • C'� Utilities: Sewer Septic Building Height:
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CONTRACTCiR
Name
Addr
City:
Zip C���
Phond
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from
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City: State: L
Zip Cod?S, (-0 Fax:
Phone No. --M"Q — 14�0c)— lo2��
ee simple Title Holder on next page (if different
I
�e Owner listed above)
E-Mail: act
i
State or County License: CK 6CT7
If valuq, of construction is 52500 or more, a RECORDED Notice of Commencement is required.
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IGNER/ENGINEER: _ Not Applicable
e:
MORTGAGE COMPANY: _✓Not Applicable
Name:
Address:
Ad
Citiress:
Zip
: State:
Phone
City: State:
Zip: Phone:
FEEiSIMPLE
TITLE HOLDER: _ Not Applicable
BONDING COMPANY: ,/Not Applicable
Na
e:
Name:
Address:
Address:
Cit
Zip
�:
City:
Phone:
i
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. Lu
whit
strut
In co
lie Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
I is in contlict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
re. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
I ideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in acc'
rdance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The f
acces
llllowing building permit applications are exempt from undergoing a full concurrency review: room additions,
dory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WA
NING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
impr
before
vements to your property. A Notice of Commencement must be recorded and posted on the jobsite
the first inspection. If you intend to obtain financing, consult with lender or an attorney before
com
encing work or recording our Notice of Commencement.
Si
ure of Owner/ Lessee/ ntractor as Agent for Owner
Signature of Contractor/License Holder
STATE
CO
OF FLORIDA
NTY OF\�
STATE OF FLORIDA
COUNTY OF,
The
thisorgo
ing instrument was acknowledged before me
day of���� 20 M by
The forgoing instrument was acknowledged efore me
this day of lA,i 20 acknowledged
Per
Name of persor7 making statement
'onally Known ✓ OR Produced Identification
Name of person making statement
Personally Known ✓ OR Produced Identification
Typ
of Identification
Type of Identification
Produced
Produced
(Signature
Co
of Notary PubliLk State of Florida)
'09Y Pue TIFFANY SUIT
o t�
_ • Commission # GG 191
ission No. * 1)
Expires April26,20
OFF Banded lltiu Budg61 NWry
(Signature of Notary Publicl State of FIRrbga )
otP Btu TIFFANY SUIT
Z ...,�
2 Fommission # GG 191
Commission No. * al
N9 \ot ExpiresApII 6,21
rFOF Fl.�� Bonded Thu Budget Notaty
2
RE
IEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DA
REC'
IVED
DA
CO
' PLETED
Rev. 8'
2/17