HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALLAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Building Permit Applicatii.i� �c qFp o2ote
Plop and Development Services
Permitting Department
Building and Code Regulation Division st. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
PhilQne: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PEWIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROU;EMENT4
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Description:
Prop��el rty Tax ID #: 1'�i �'�- 3 � �=�3� - hn� -I Lot No.
Site Ian Name: Block No.
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Proj�'ct Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DE$CRIPTIONOFbWORK��
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CO STRUCTION INFORMATION
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i, iona work to a er orme under this permit - c ec a apply:
11
�d HVAC Gas Tank Gas Piping _ Shutters Q Windows/Doors
1 Electric F1 Plumbing Sprinklers I Generator Roof S IZ Roof pitch
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Total Sq. Ft of Construction: 241� n S . Ft. of First Floor:
Cost Qllf Construction: $ an�, d I�_ Utilities: Sewer F] Septic Building Height:
III
OWNER/LESSEE.
CONTRACTOR
Name
Name:
Addr
Company: 011I0
1e2 Stater
City:
Address:
Zip CAI
de: 3S ( Fax:
City:State:
Phon
No.
Zip Code: Fax:
Ii':
E-M
Phone No. '—`tea— y�`�?—l9
ee simple Title Holder on next page ( if different
I
Fill in
E-Mail:
from
a Owner listed above)
State or County License:
If valu
of construction is $2500 or more, a RECORDED Notice of Commencement is required.
S_IAPREEI
IENTAL CONSTRIJCTI®N EN f. UV IN'F®R!\/IAi'I®N:
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
city:
State:
City: State:
Zipi:
Phone
Zip: Phone:
FEE
SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Applicable
Nln
_
ne:
_Not
Name:
Address:
Address:
City:
City:
Phone:
Zip: Phone:
ZI II
OW , ER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I ce �ify that no work or installation has commenced prior to the issuance of a permit.
St. L cie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
whichis in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
strud lure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In colnsideration 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 f�llowing building permit applications are exempt from undergoing a full concurrency review: room additions,
acce isory 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
inibvements 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
comjnencinl; work or recording vour Notice of Commencement.
of
as Agent for Owner mature of Contractor/License Holder
STATE OF FLORIg STATE OF FLORID
COUNTY OF e� COUNTY OF �e—
Thefforgoing instNr ent was acknowledged before me The forgoing ins
thisi day o 20JR by this ay of
Name of person making statement
finally. Known _L ___-QFF Produced Identification
of Identification
re of Notary Public- State of Florida )
;ion No. :510 (Seal)
P
before me
.. by
Name of person making statement
Personally Known _[___—OR Produced Identification
Type of Identification
Produced
64MACC-?
ignature of Notary
Public- State of Florida )
Commission NC12sa c_41 al!!otary Public Stetelt
Amanda P 9andei
�'y Commission GG
,OF Expires 04125/2022
R VIEWS FR 1SOn {b /Is PLANS VEGETATION SEA TURTLE MANGROVE
�I CO 2SW12i R VI REV REVIEW REVIEW REVIEW
DATE
RECtIVED
COlyl PLETED 4
Rev. 9IY2/17