HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLE i eo fOR APPLICATION TO BE ACCEPTED
Date: VA\ A �N!N. Permit Number:
SCANNED
BY
St. Lucie County RECErvFn
Building Permit Applicat on APR"
g
Planning and Development Services
Building and Code Regulation Division sT• Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982 I
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential v
Property Tax ID #:
Site Plan Name:
Project Name:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction::
Cost of Construction: $
Shutters
_ Generator
Sq. Ft. of First Floor'
Utilities: _Sewer _Septic Building Height:
—Windows/Doors
_Roof Pitch
OWN R/`L
eNTOCCQR:
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Name ST•9-V-9A5 48
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Name:
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Address:( 0-1 51vd(at)
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Company:
City: -FA- (�( u-cip—
Zip Code: 2.) g 2 Fax:
Phone No. LN
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Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail:
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.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
S_IJ.P.P.HEMMENT_ G[2N51Ti._ MUM LI -N LAW INFINNSTIM
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
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 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH 40"R LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature f Owner Lessee/C ntractor as Agen --.for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY
COUNTY OF
OF S LuC-�'�
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledge before me
*
this day of 20_ by
this �_ day of Q P ♦- 20 by
M%\s VN 'IM a, 16\ \
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification
Produced kCV� h
(Signature of Notary Public- State of Florida )
mmission No. (Seal)
(Signature of Notary Pu lic TYJoria�NNpM,� ;,,; s�ivo-,
"k o. EXPI c 7ir'ti IIA�� i
Commission No. ,T"••eoi�gs'b"Rifrc±rlG,!1,,
i�Ofaf!'P4hI�Ilr��i2r�.
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S.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev 2/7/19