HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APP
Date:
INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
FRECEIVED
Building Permit Applica I
1 "►Y d D I 4-S t ii 1
P ann► g an eve opmen erv►ces
euildi and -Code Regulation Division
2300 v,irginia Avenue, Fort Pierce A 34982
Phon I' (772) 4624553 Fax: (772) 462-1578 Commercial Residential
PER IT APPLICATION FOR:
%�f4-
Addresc'r
Legal D ascription:
Propert Tax ID #: I Z? l UU CJtJ l l .yUU IU
Site Pla Name:.
ProjectName:
Setbac ,s Front . Back: Right Side: 41. h Left Side:
)A C_V`i1Q1Ve"C12 _ko OZ
2des 5'K +Z► 'c4i 1�C
Lot No.
Block No.
Aaaitl , al work to be pertormea under tnis permit — cnecK aii tnat apply:
_rV echanical _ Gas Tank _ Gas Piping. _ Shutters _ Windows/Doors
ectric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total S . Ft of Construction: y�J� 0 Sq. Ft. of First Floor:
Cost of (Construction: $ UI Utilities: —Sewer —Septic Building Height:
�,.
F -
Name
'(I U Sfi ffi
Name:
Company:
Addrel;s: A
City: -&V- — State: L
Address:
City: State:T
Zip C 'ode: ?4R51 Fax:
a
Phon No. `(] 2 Si Z� 1 `I
Zip Code: Fax:
Phone No
E-Mai
: '.
Fill in
ee sim a Title Holder on next page ( if different
E-Mail
from 1,.he
Owner listed above)
State or Count License
IIf value f construction is 2500 or more, a RECORDED Notice of Commencement is required.
WJ
DESIG ER/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:
i
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 i� 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.
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 follo I ing building permit applications are exempt from undergoing a full concurrency review: room additions,
accessoy 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 inspe tI ion. you intend to obtain financing, consult with lender or an attorney before
commencingwo r rec.0Fd1W your Notice of Commencement.
'V
ngtb ofsOwner:Lessee/Confract&'!as�Ageni for Owner__
Signature of Contractor/License Holder
I
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowled a before me
The forgoing instrument was acknowledged before me
thisaday of �c A� , 20rA by
this day of 20_ by
Je
JK X�� s
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
(Signature of Notary Pu i -
(Signature of Notary Public- State of Florida )
®�NNpryIpREGIVENS
GG 022023
i,(p MY COPdI1SN 16
Commission No. MAar,2020 11
Commission No. (Seal)
B d?hru Notary Fub11r Undenudter
,'•FOF
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COMPLETED
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