HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICA LE IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 1 SGA Nam Permit Number: I qc J' wIa
IVY
St. Lucia CoJ*
- Building Permit Application R`�Eri,En
Planning and Developmentservices MA,,
t
Building and Code Regulation Division permitt lea?
FL 34982 St
2300 Virginia Avenue, Fort Pierce Cvc eDe �!
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential un
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: ".
Address:
Legal Description t -
-/
Property Tax ID #: — �� ' �t��aS �ll7l l— c� Lot No.
Site Plan Name: Block No.
Project Name: r Q r 0 Q
Setbacks Front Back: Right Side: Left Side:
'DETAILED DESCRIPTION OF WORK: °
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f d dT�CIpI//,n -rL)gp- 7,to
'CONSTRUCTION, INFORMATION: ' - n
itiona wor to e e orme un ert apermit—c ec a appy:
IIHVAC MGasTank []Gas Piping Shutters ❑Wi ws/Doors
11 Electric Plumbing Sprinklers L� Generator Roof Roof pitch
Total Sq. Ft of Constru ion: Sq• Ft. of First Floor:
�—� OSeptic
Cost of Construction. Utilities: Sewer Building Height:
R/LESSEE: ;.•
"CONTRACTOR;
`L �(��' ,. ���L
Name: t_��IO�JI�
Company: J1n
r
Address: S
t F �e State
City: mien Q Old State:_
�ZI�1 �S ax:
Phone No.
Zip Code: Fax:
E-Mail:
Phone No --I
Fill in fee simple Title Holder on next page (if different
E-Mail: 1r I c,kA U c&
I 0. D
State or County UcenseX C
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
17
SUPPLEMENTALMNSTRUCTION LIEN'LAW INFORMATION: _
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address:
City:
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 Coun�v 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.
Inconsideration 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,
accessary 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 your Notice of Commencement.
i atur One Lessee/
tractor as gent for Owner
ure of Contractor/Ucense Holder
ATE OF FLO
STATE OF FLOR
COUNTY O
-2
COUNTY OF . )\ U OAw
The fro' try�n�pt was aFknowledge efore me
this day of / ► L iti— 20_M
The forgoing Instrument was acknowledged before me
day of 20_ by
Name of person makintate n e t
Name of person ng statement
Personally Known ----OR
Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Flo i d
ature of Notary Public- State of I '
Stele of
//�1
Commission NG.� ��
(S ry Public Stele of Flpii
anda P Sanderson
fa ( Nobary Public
o
Co ission No. � bi�da P Sanderson
oG 2112
MY Commission GG 2712
04/2512022
ommission
d Expltea 0412512a22
Explres
Ap gyp'
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17