HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONt
ALL APPLICABLE INFO MUST 136_6MPLETED FOR APPLICATION TO BE ACCE: ',
Date:
Building Permit Application SCANI RECENED
Planning and Development Services Sf Lucie
Building and Code Regulation Division COUPIO 10 2fl�
2300 Virginia Avenue, Fort Pierce FL 34982 - -- — - — - erermmi'U g eelo unent
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential St. Lucie County
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: _
Address:
r
Property Tax ID #: �y/() — 6�a��/� - QW O
Site Plan Name:
Project Name:
Setbacks Front Back: �e{ ' Right Side: Left Side: / S
Lot No.
Block No.��,
DETAILED DESCRIPTION OE WORK: 3 pdu
N&w / III
LdrrIPUGTi.� O/- rlL -� f3earovor . - i ✓sti 1-
CONSTRUCTIOWINFORMATION:
Arir1mnna wnr to a na nrma .. un ar f rc narmrt—rhPr nil -t ztF annr
LJHVAC I I Gas Tank UGas Pi
Electric Plumbing []Sprint
Total Sq. Ft of Construction:—,721
Cost of Construction: $ eX' od
f . A i L/ A71
ng UShutters Q Windows/Doors
ars 11 Generator O Roof Roof pitch
S Ft. of First Floor: D. -?
Utilities:Sew44septic Building Height:
OWNER/LESSEE.r f.;.
?,CONT�RACTOF2:
Name I
Name:
Address: -fdz,i Cio,l k /r,
Company:
City: E f 640« State:
Zip Code: 3I ,Vg')_ Fax:
Phone No. -7 i - d - 4o F
E-Mail:
Address:
City: State:_
Zip Code: Fax:
Phone No.
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 $Z500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
-DESIGNER/ENGINEER:
Name: 6C ae.;
_—Not-Applicable
n(.n., .
-mORTGAGEC - MP PI Y. _ Net-Applicabl
Name:
Address:'
I
Address:
City:
Zip: Phone
State:
1 - 3a
City: State:
Zip: hone:
FEE SIMPLE TITLE HOLDER:
Name: IName:
Not Applicable
BONDING COMPANY: _Not Applicable
Address:
I
Address:
City:
City:
Zip: Phone:
Zip: one:
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 tain financing, consult with lender or an attorney before
commencing work ooff``recardine vouf No ' e of Commencement.
as Agent for Owner I Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instr ent was acknowledg before me
this day of � 209 by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
0'
(Si ture of Notary Public - State of Florida )
Commission No. f_
MYCWWV
0
I E%P
REVIEWS FRO ONING
COUNTER I REVIEW
Rev.
The forgoing instrument was acknowledged before me
this _ day of 20_ by
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
(Signature of Notary Public- State of Florida )
Commission No.
Mi
SUPERVISOR I PLANS I VEGETATION
REVIEW REVIEW REVIEW
(Seal)
SEATURTLE I MANGROVE
REVIEW REVIEW
C_