HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONf
ALL APPLICABLE INFO MUST
BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I - CD- S 1® Permit Number:
a RECEIVED
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Building Permit Application OCT 2 61gg
Planning and Development Services Perrni�in
Building and Code Regulation Division SCANNEDtF; �e a artrnent
2300 Virginia Avenue, Fort Pierce FL 34982 BY
.-9URI*�S
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial St Lucie ptial
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal Description:
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Property Tax ID #:
Site Plan Name:
Project Name: _
Setbacks Front
1 /i hl
.. _92"25
Back: Right Side: Left Side:
Lot No._
Block No.
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11 Electric ❑ Plumbing Sprinklers Generator _ oof
Total Sq. Ft of Construction: �!;�L C)r) S . Ft. of First Floor:
Cost of Construction: $ 9 4!1 . a-) Utilities: 0 Sewer Septic Building Height:
"Shutters
Nam L/
Name: "
Company:
Address:
City: e"
Address: Q. I 1AAAAlk,
City: P I e State.
Zip Code: Fax:
Phone No. °��� ��Q 3?, -�-)(� �Q
Zip Code: � (Q r'�- Fax:
Phone No. a- -(woI
E-Mail: 0 C
State or County License: 000
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
IT vaiue oT construction is }z5uu or more, a RECORDED Notice of Commencement is required.
aWindows/Doors
Roof pitch
Not Applicable I MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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 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 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
commencing work or recording vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Sig ure of Contractor/License Holder
STATE OF FLOPA
STATE OF FLORID
COUNTY OF �
COUNTY OF
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Name of person ma ing statement
Name of person modg statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of N tary Public- StISTShature
I ] Notary Public state of FloOn
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of Notary Public- State of Florida
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�' 6 Notary Public State o
Commission (� � (S�AI��n?e Sanderson
OG 211
Co fission No. I )Amanda P Sande
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My Commisswn
Expires 04I2512022
My �ummission GG
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REVIEWS
FRONT
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SUPERVISOR
PLADK
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
RE,V W
REVIEW
REVIEW
REVIEW
DATE ,
RECEIVED
DATE
COMPLETED
Rev. 8/2/17