HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL
Date:
1
INFO MUST BE,C'r . '. PLETED FOR APPLICATION TO BE ACCEP'rCu' r�
Permit Number: p Vy /
RECEIVED
• y
AUG 3 020
Building Permit Application h
Planning and Development Services `!� • Y Pr9tting Department
Building) and Code Regulation Division ®�� St, Luce County
230014 inia Avenue, Fort Pierce FL 34982
Phond'�772) 462-1553 Fax: (772) 462-1578 Commercial Residential
FPERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LCICATION:.
Address: i 13 A A eT,f eR D Y i Ire IFS k`e,)o , V�L q 4,f Z
Legal De pription:
Property ITax ID #: 3y O 000 " 1
Site Plan ame: T`^�iG� 1rc✓ 1>4, �s — utjr 1
Project Npme:
Front Back: Right Side: Left Side:
Lot No.5s36 137
Block No. L{
DETAIL�D DESCRIPTION OF WORK:
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:)NSTIIUCTION INFORMATION:
ition A work to b MGasTank
orme un er t is permit —c ec a app y:
_HV C ❑Gas Piping _ Shutters Windows/Doors
Elie, is ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq.
Cost of C
t of Construction:
nstruction: $ a.OLVDC)
S Ft. of First Floor:
Utilities: —Sewer Septic Building Height:
OWNED/LESSEE:
CONTRACTOR:
Name
Address:
City:
Zip Code
Phone Nol.
E-Mail:
Fill in fee
from the
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Name:
Company:
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State:'
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Address:
City: State:
Zip Code: Fax: .
Phone No.
'E-Mail:
I 1�eJ�lkol(� u� (• tymn
simple Title Holder on next page: (if different '
Owner listed above) .
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPP IIIEMENTAL
i`
CONSTR CTION LIEN LAW INFORMATION:
DESIG'
Name:ll
Address:
City:
Zip:
ER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
State:
Phone
FEE Sl
Name.
Address:
City: II
Zip: II
PLE TITLE HOLDER: �[ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
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 tf at no work or installation has commenced prior to the issuance of a permit.
St. Lucie lunty makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is i �Iease
conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. consult with your Home Owners Association and review your deed for any restrictions which may apply.
In conside fation of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accorda ice with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The follom ing building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory tructures, 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
improve ents to your property. A Notice of Commencement must be recorded and posted on the jobsite
before tl ie first inspection. If you intend to obtain financing, consult with lender or an attorney before
commer cing woAk or recording your Notice of Commencement.
1� \-4-- 0 t Y_'f�
Signaturl of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE QF FLORIDA STATE OF FLORIDA
COUN OF S- Lc��� -r COUNTY OF
The trg ing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 66. day of 20_Zk by this day of , 20_ by
me of person making statement Name of person making statement
Persona Known OR Produced Identification -C- Personally Known OR Produced Identification
Type of ld�entification Type of Identification
Produce cl�i Produced
(Signatue of Notary Public- StaWof Florida) rA
+'I/'' (Signature of Notary Public- State of FloridaCommis ion No. (Seal) : Commission No. (Seal)
REVI S FRONT ZONING S f"� REVI W VEGETATION S REVIEW LE MANGROVE
COUNTER REVIEW
DATE
RECEIVED
11
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DATE
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COMPL&ED
QX �' T
Rev. 8/2/
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