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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /� 2 Date: Permit Number: SCANNED _ BYo Building Permit Application St Lucie Count ,e Planning and Development Services d iT eot Building and Code Regulation Division �eQa J 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEMENT LOCATION: Address: ' 110 3 CcJ _ CI�cJ., ,cs:_.. Legal Description: �[l t9'!e lh&& ,S_ L91 ny �3 Property tax ID#: 303-Iolo-©OS9-0007 Site Plan Name: Proiect Name: Setbacks ' Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: % 4,r 'tj I CONSTRUCTION INFORMATION: Lot No. Block No. Additional work to ne nejrrormea unaer tnis permit — cnecK an apply: nHVA0 Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors CElectIric - Plumbing Sprinklers Generator Roof ^ �� Roof pitch Total Sq. Ft of Construction: 1 5140 So. Ft. of First Floor: ly Cost of Construction: $ co to © D Utilities: Sewer Septic Building Height: OWNERAESSEE: CONTRACTOR: Name Name: Address: I Company: City: cOJt.CU State: = Address: 3 D U Zip Code: 3 tl5q4l Fax: City: CIN State: Phone No. I Zip Code: "36W=3a Fax: E-Mail: Phone No. L107 — S -- F% a Fill in fee simple Title Holder on next page (if different E-Mail: s r Ion -e f S' rr oc>f er, , /A -F,.-) from the Owner listed above) State or County License: dC C /3 a 0& .S If value of construction is S2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:. DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: � Name: Address', Address: City: State: Zip: I Phone :: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: of Applicable BONDING COM Not Applicable Name: Name: Address' Addres . 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 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 1 will, in all respects, perform the work in accordar Ice 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 cnmmpncine' vork or recordine vour Notice of Commencement. /7 — � as Agent STATE OF FLORIDA II STATE OF FLORID J,dC COUNTY OF /DP'I d C", COUNTY OF �L[`r The forgoing instrunv t was acknowledge fore me thi�iday of 20by ime of pe[son �making statement Known Y bR Produced Identification Type of The forgoing instrument vyas acknowledge before me this day of 20 y Name person making statement Personally Know OR Produced Identification Type of Ide ' ication Produced I` Notary Pub ' (SignaturLvof Notary Pub - � afI rr �ubltc State of Florida aV� Notary Public State of Florida Kelley Castro ,P . Ion GG 240879 Kellbg�itstro ommission No. My No.� My commission GG 240879 a Expires 0 y2022 w Expires 07/22/2022 FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE Rev.