HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPI_ICARLF INFO MUST BF COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
,. .•.RECEIVED
Building Permit Application aaN-6a•iols
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772).462-1578 Commercial
PERMIT APPLICATION FOR:
Address:
Legal Description:
,ermitting Department
St. Lucie County
Residential
PropertyTaxlD#:
Site Plan Name:
Project Name:
Setbacks Front 2fS ► Back: Right Side: Je9g! LeftSide:
m
Lot No.�/�
Block No.
HUUMUrItlI WUrK LU UU pCrIUrIIIUU unuer Unb penn1L—U1UILKdn LIIdL dpply.
Mechanical _ Gas Tank _ Gas Piping _Shutters windows/Doors
t%Electric (Plumbing sprinklers _Generator %Roof fp7Z[Q`Pitch
Total Sq. Ft of Construction: ?,3 Sq. Ft. of First Floor: 6 3 3S-
Cost of Construction $�4^ "'4"•{1•? r' ^" '':=. Utilities: _Sewer VSeptic Building Height: �-" r
OW N ER/LESSEE:
CONTRACTOR:
Nano 51
NalSle
r1
Address: a/✓ci F +,C
mA an S
�Yfx::i1. (^
Add�'ess
City: s L State: /y
Zip Code: 3 y 953 Fax: 2721. 873- edG 77
Phone No. 95�0- 3 2 S- 3/'? -F
City: RIOLMt "4:w Stater
Zip Code: 3317q Fax:
Phone No eZ�
E-Mail: 44f° A9-164,-e—r T:5T • C-O'"t
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail t^ e4V_1 I cit1•
State or County License C GC f SDS-14t
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
S PPLE-MENTAL CONSTRUCTION
LIEN LAW I
FORMATI
DESIGN[/ENGINEER:
Name: vr.� W>=C4! inr�.
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Addres :_/9$cl9,.� i3.tT...eo��
ST
Address:
City: �.t% Sf Lucre=
Zip:3tL9SfcL• Phone-»a-7g5-4S14sSZ
State: r�r�
City:
Zip: Phone:.
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
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 irf conflict with any applicable Ijome OwnersAssociation 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'f�ereby agree that I will; m all Fespects; 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 room'§ and'accessory'ukito 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
commencin work or recordin • our Notice of Commencement.
010
.
Si ature of Owner/ Lessee/Contractor. as Agent for Owner
Sig na� f ContZactoY/License HoI�Jder ,
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF �•�
COUNTY OF �TiYZ(%- L ✓' ` `` -
The [__oSSgoing instru nt was acknowledged before me
'i
The rgoing instru ent was acknowledged before me
%eC
this day of 20t`� by
this _day of • 20/8r by
Name of person making staterVen
Name of person making statement.
Personally Known OR Pcpduced Identification �
Personally Kgown __,�/OR Produced Identification
Type of Identificatio •
� ��"
Type of Identification
Produced
Produced
•
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