HomeMy WebLinkAboutBUILDING PERMIT APPLICATION0
ALL APPLICABLE INFO MUST BE COMPLETED, FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:,��
RECEIVED
Building Permit Application
Planning and Development Services NOV zo1�
Building and Code Regulation Division ST. Lucie County, Permitting
2300 Virginia Avenue, -Fort Pierce FL 34982
Phoned (772) 462-1553 Fax: (772) 462-1578 COmmercial Residential
PERMIT APPLICATION FOR: To Select from dropbox,-click arrow at the end of line
PROPOSED _ME J�
"T LOCATION ,
Address ,� • • •
Legal Description: -O/
Property Tax ID #: cJ(_1 V��
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
�Hi VAC Gas Tank- Gas
aElectric E]Plumbing 0Spt
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Total Sq. Ft of Construction:
Cost of! Construction: $ 't
Lot No.
Block No.,
QWindows/Doors
Roof C
S Ft. of First Floor:
4� O , d Utilities:USewer Septic Building Height:
Name
Name. V . 2
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Zip Code: %Sr� Fax:
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State: F'G
Phone INo.
Zip Code: �TiPC3' Fax:
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E-Mail:
Phone No.
Fill in fee simple Title Holder on next page ( if different
E-Mail: d - P.
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from the Owner listed above)_
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State -or -County License: c'
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If value' of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SIJPPLEMENTAL,CONSTR
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DESIGNER/ENGINEER: -
_ Not Applicable
MORTGAGE COMPANY:
_ Not'Appllcabler
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% CONTfrtACTOR 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. 1
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 Commercement 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 worl5..gr recording your Notice of Commencement.
signat of°.Owner/ Lessee/Contractor as:Agent for Owner
Signatur of o ractor/Li, cense Holder
STATE OF .FLORID
COUNTY OF F I•.h V�
'STATE OF FLORIDq�
C.
-ti
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 14 day of A/vv , 20 lk by
this tlt day of /Uw , 20'IJ- 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 Ide tificatio
Produced f -t=f t/��
Produced L-�" I u, l.Z
(Si ture of Notary Public- State ) 'Daniel Stewart
(S' nature of Notary Public- State of Florida)
NOTARY PUBLIC
Commission No. G 610 e )STATE OF FLORID
Daniel Stewart
Commission No.G-c'ne%� �o
tNOTARY PUBLIComm#GG176108
g
o OF FLOR
Expires 1/17/202
PSTATE
Conm# GG1761
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW , -
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
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