HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAILAPPLICABLE INFO MUST BE COMPILE. __ FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: / D/a C/ C230
Building Permit Application SCANNED
Planning and Development Services BY
St. Lucie County and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 />
Phone:.(772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address:
Legal Description:o XLdj /J nPia /6 e�orK !.2 IfipiAIJ RIVER t STHiti
Property Tax ID #: Lot
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No. 12
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator v+Roof Pitch
i2
Total Sq. Ft of Construction: 1 U)n CG . F4. Sq. Ft. of First Floor: 2t'1.,_
0 0
Cost of Construction: $ 'll'Ji� /1� Utilities: =Sewer _Sep tic Building Height:
?y
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(TRACTOR j '' �W +. Wwe �,k
Name - � i c -
Name: rJ ru of r
Address_6.,VC Ir-t /)r-
Company:
City: 1-o Pl erc, Stater
Zip Code: 3 V!9 82 Fax:
Phone No. C 7_' 7 2 > 0 / G - 3 �3
Address:
City: State:_
'Zip,Code: ° Fax:
'Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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 is of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
is in Home Owners bylaws
which conflict with any applicable Association rules, 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
commencingwork or recordingour Notice of Commencement.
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DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
-Name:
_Not Applicable`
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
I
I
I
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA ,
COUNTY OF G,.f- Luc.cv
COUNTY OF
The for oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this �ay of 7�Ge 20�i' by
this _day of , 20_ by
/778411 l�i�' t�l DAL rJ
(Name of person acknowledging)
(Name of person acknowledging) �
(Signature of Notary Publi ate of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
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Personally Known OR Produced Identification
Type of Identification
Type of Identification
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Commission No. (Seal)
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mmission No. (Seal)
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DATE
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COMPLETED