HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
11 SCANNED
Date: Permit Number:
BY
a tSt. Lucie ®unV RECENED
Building Permit Application AUG 2 2 2017
Permitting
P I nning and Development Services Department
partm®nt:
B ii lding and Code Regulation Division St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
P�lone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PE��IVIIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Addr0ess: �,9?'0�J_ M G=C k O eA e- b1'• IV -
Legal Description: 1'7e/p Ae,--e S Z of11
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Propel rtyTaxID#:a?i�d/®O%�Lyf���
Site )?Ian Name: //off/Q��'L��
Project Name: C v'e;°.t
Setbacks Fronts Back: Right Side: eq?0 Left Side: aO r
Lot No.
Block No.
onai worK to oe
HVAC
Electric
nej
L_1
rrormea unaer tnis permit- cnecK all
Gas Tank' ❑Gas Piping _
Plumbing Sprinklers M
apply:
Shutters a Windows/Doors
Generator Roof Roof pitch
0
Total Sq. Ft of Construction:
Cost elf Construction: $ I T{ly
S Ft. of First Floor: _
Utilities:Sewer Septic
Building Height:
Namej 6-kKeS 4— A hQ
Name:
Address: /Nno'( %�i� j �`.iiG
Company: ) MY G '
City: State: r— -
Address:
Zip Code: fO Fax:
State:
PhonelNo. %/���� $!�
Zip Code: Fax:
Phone No.
E-Mail:
E-Maili farA I e laeb aq Can—
Fill in flee simple Title Holder on ne)& page ( if different
from the Owner listed above)
State County License:
or
it value pt construction is !�z5oo 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:
p: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: XNot
Applicable
BONDING COMPANY:
Not Applicable
�."lame:
Name:
ddress:
Address:
City:
City:
Zllp: Phone:
Zip: Phone:
OW' NER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I c III 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.
11
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in alccordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
Thei'fol[owing 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
W RONNG TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
mp Ii
Irovements 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
co mencing work or recording our Notice of Commencement.
1l
Si it a ur of Owner/ Lessee/Contractor gent for Owner
Signature of Contractor/License Holder
STIATE OF FLORIDA f7
STATE OF FLORIDA
COUNTY OFy'-PVar
COUNTY OF
Thli forgoing instru ent was acknowledged before me
The forgoing instrument was acknowledged before me
th i`,� day of V 20� by
this _ day of 20_ by
r1 vLXX
Name of person makin tement
Name of person making statement
Perisonally Known OR Produced Identification
ersonally Known OR Produced Identification
Type of Identif gption
a e of Identification
Pr
Produced
uced
S��G� S`a�e Og39
�20
(Signatur
of Notary Pub[' ate♦♦ft�fa
.
(Signature of Notary Public- State of Florida )
Commission
No. , ; e
o.
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
I'I
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev. 8%2/17