HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLY FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Recevso
p�j I",
Building Permit Application rm,Kin9�ePaftment
Planning and Development Services ;county SCANP
Building and Code Regulation Division BY
2300 Virginia Avenue, Fort Pierce FL 34982 �Aa•• Lucie
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: )zC net�CL fISI�
PROPOSED INPROUEMLO ENT GATION:
Address: ScS—D / THee
Legal Description:
Property Tax ID #: I ! 07 ' 31a
Site Plan Name:
Project Name:
Setbacks Front Back:
61//
Right Side: Left Side:
— cnecK a
_Mechanical _Gas Tank _Gas Piping _Shutters
_Electric _Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: _ ��//�, Sq. Ft. of First Floor:
Cost of Construction: $ O 5W0' YP Utilities: —Sewer _Septic
Lot No.
Block No.
Windows/Doors
Roof Pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:.
Address: SS-0/ T�PP rb T�
Cpmp�ny?'•
City: �D/ f JD/P� e Stater
Zip Code: '� ci Fax:
'9—IZ0I
Phone No. % 2ZD
'772-
"I PIJ
Address; -
'='-----'="-''----
Zip Code:'
Phone No
- State:
Fax:
E-Mail: Ye,*177A-liih ® �,qwlpd. ow"
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.
A&
SUPPLEMENT L CONST ION MEN LAW INFOR
ATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
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 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 obtain financing, consult with lender or an attorney before
commencingwork or recordin our Notice of Commencement.
Sign re of OwnW1 Lessee/Contr *tor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF
The forgoing instr ment was acknowledged before me
The forgoing instrument was acknowledged before me
this � day of VP 20% by
this _ day of • 20_ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identificationy
Personally Known OR Produced Identification
Type of Idegfilca ion
m-4-
Type of Identification
Produced V't
Produced
(' a 7Kre of Notary Public-S "te of Florida)
(Signature of Notary Public -State of Florida )
Commission No.
Commission No. (Seal)
A N-N ORAtd RAFIAUN6
:; WCOWMIO 960275=
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