HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Application 1410j8
Planning and Development Services Permittin
Building and Code Regulation Division St. Lucieg D epa",ent
2300 Virginia Avenue, Fort Pierce FL 34982 y
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential JV
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PERMIT APPLICATION FOR: I
Address: Is,
SCANNED
Legal Description:�_1`VP�
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Property Tax lD#:
Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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A itiona wor to perorme un ert ispermrt—c � "�� �`.��'s' ��""""`
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_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator Roof � 62 2itch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: / III �// �// "
Cost of Construction: $ ,too Utilities: _Sewer _Septic Building Height:
Name
Name:
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Addre I Com an � G i
City: (� - State: I Address:
Zip Code: Fax: Cit Y State:
Phone No. 2 (J _ Zip Code: 3 Fax:
E-Mail: qq
Phone No d`db
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above). State or County License C
f value of construction is 25nn nr mnre a RECORDED
Notice of Commencement is required. i� (07 G
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DESIGNER/ENGINEER: Not Applicable
_ , MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: I 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
commencing work or recording our Notice of Commencement.
I Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
ISTATE OF FLORIDA STATE OF FLORIDA c�
COUNTYOF Sq—ytt�{C� ICOUNTYOF
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The forgoing instrument wa5 a knowlecig efore me 1 The f r oing instrument was acknowledged before me
this., day of , 20 by this day of . 201Tby
w�I�l/
(Name of person acknowledging) (Name of person acknowledging)
I� (Signature of Notary -Public- State of Florida) (Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification i Personally Known OR Produced Identification
Type of Identification I Type of I
Produced Ur I rN VAUGHN Produce
State of Florida -Notary Public �� `:State GHN
Pof Florida-
- +` Commission 270979 = ,e Com Notary ply
Commission No. _ 0 ex Tres I Commis missio 0-_
commis P �., �na�.=---tom GG 270
Ply o� 79
October 22 2v22 sion Ex i
October 22,
2022res
REVIEWS FRONT I ZONING SUPERVISOR i PLANS VEGETATION SEATURTLE MANGROVE
COUNTER I REVIEW I REVIEW REVIEW REVIEW I REVIEW REVIEW
DATE
RECEIVED
DATE
j
p
COMPLETED
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