HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APF ICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dafe: Permit Number:
SCANNED
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BY It RECEIVED
. at Lucie County
' SFP 1.12010
_ Building Permit Application
Plann g and Development Services Permitting Department
Buildi I g and Code Regulation Division St. Lucie County
2300 irginia Avenue, Fort Pierce FL 34982
Phone : (772) 462-1553 Fax: (772) 462-1578 Commercial Residential X
PERMIT
APPLICATION FOR:
II
RC}PaIlSIlEDpNPRQLO A I®N:
Address: `1—I�U
( �OlrGleifl �P (1 QIA
Fn (->-
Legal II scription: 1)l G-" S 3 0 S V2 DES,V2 OF
+ -- (2 • CIS ACMAP 3L1 /05 39gto-i
Property
Tax ID #: 'R� 2— I �� " d� ' �P Lot No. 190
Site PI
n Name: Block No.
Projec
Name: -
Setba(I s Front Back: Right Side: Left Side:
I
DETAILED DESC«R�IPTION OF ORK:
F
P
C0
STRUCTION INFORMATION:
iti
na work to be performed under this permit— check all that apply:
_
_
Total S
echanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
lectric _ Plumbing _ Sprinklers _ Generator M RoofFTIN.
3)(12 Pitch
. Ft of Construction: Sq. Ft. of First Floor:
Cost o
'Construction: $ �JUtilities: —Sewer —Septic Building Height:
®WNiE
/LE�S�SEE:
CQNTRACTOR:
Name
Add r
1swe, muc, ow
Name:
Iss: Lit -I1bI '-fOroen$en Kcod
Company:
F-n(+ Pietce State: FIIL
6 ( Fax:
Address: .
City:
Zip C)de:
City: State:
Phon
No.,: n 0 — 60
Zip Code: Fax:
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fee simple Title Holder on next page ( if different
E-Mali:
Fill in
Phone No
E-Mail
from
the Owner listed above)
State or County License
If value
of construction is 2500 or more, a RECORDED Notice of Commencement is required.
9)
S PPLEMENTAL SONS R IgLIEN LAW IEN'FORMA ION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
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, ruIes, 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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commen,aip rrk or recording your Notice of Commencement.
i`- -
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY COUNTY OF
The forgoing instrument was acknowledgSA before me
The forgoing instrument was acknowledged before me
this LL__ day of 20Z by
this day of 20_ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
,Type of Identification
Produced
Produced
Sign ure bf Notary Public- State ftFloricla)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PL S
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REV
REVIEW.
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 9/2/17