HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONRI
All APPLICABLE INFO MUST BE COMPL2,. J FOR APPLICATION TO BEACCEPT
Date: `� '� Permit Number:
r
ED
+.�. SCANNED RE]08
BY
- St. Lucie Cognty APR20igBuilding Permit Applicati nPlanning
and Development Services ST. Lucie Permitting
Building and Code Regulation Division -----
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: C
PROPS@D IMPROVEMENT
LOCAITION,
Address: - 10 9 PSe
Legal Description: /Jar- i G>(ee(( 7� 16�,2 3el
p
Property Tax ID #: Lot No.
Site Plan Name: FCA/Ge� Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION// OF WORK:
CON5TRUCTION INFORMATION:
rtiona war to a pe orme un er t is permt---CM7K-ff11 tat apply:
_Mechanical_Gas Tank —Gas Piping _Shutters —Windows/Doors
Electric _Plumbing —Sprinklers Generator Roof Pitch
Total?( Ft of Construction: 8 i- Sq. Ft. of First Floor:
//``
Cost of Construction: $ '41 Utilities: —Sewer _Septic Building Height: ^
OWNER/LESSEE:
CONTRACTOR:
Name R uW// Rdo(4o //
Name:
Address: d 4 51. P/PCB-1,4 e-1, u7 '
Company:
City: S t State: _t
Address:
State:
Zip Code: 3 y 4 P 3 Fax:
Phone No. 717-Z - G 3� S� 3 S I
i ode: Fax:
E-Mail: ' '
Ph a No
Fill in fee simple Title Holder on nex page ( if different
E- ail
from the Owner listed above) ,
Sta a or County License
If value of construction is 2500 or more, a ncement is required.
SU PLEMENTAL CONSTRUCTION LIEN' LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Neot-Applicable
' 1
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
!State:
City: State:
Zip': Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
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
commencing work or recordine vour Notice of Commencement.
al
'9'd
Signat re o Owner/ Les a/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE
STATE OF ORIDA
COUNTYOFORI�A
5 Lucc
COUNTYOF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this X day of et tl 20 \A by
this _ day of . 20_ by
�'s .)Sf\n sh
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Pu
NAMARIEGNENS
(Signature of Notary Public- State of Florida )
_ G
'.�y.. "• "4 My OMr�ISSION # r 022S23
Commission No.*da
Commission No. (Seal)
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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