HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLI BLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:_ SCANNED Permit Number:
BY
St. Lucie County
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMITTYPE: 0.. 1, /1
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Building Permit Applica-
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Lucie county Perm
Commercial � _ Residential ift.,_
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Address: -_XD01J Ii� l.(,_'�- -I r-D(-t i� 1 �, Ir( c'>`M d d
Property Tax ID #: Za c Y��-�� --�� -000-4- Lot Nd cl' '
Site Plan Name: _W I ` I\� fr Block No. 4
Project Name: \._0 1 1 1�
CONSTRUCTION INFORMATION: 11 a' 4 P
Additional work to be performed under this permit— check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: 1 , COC7O Sq. Ft. of First Floor: _
Cost of Construction: $ _ 1 of., [ QQ Utilities: _ Sewer _ Septic
_ Windows/Doors
IToof Pitch
Building Height: 1
OWNER/LESSEE't
CONTRACTOR:
Name
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Name:
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Address: (�
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Company: U •
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City: r + roe. 5 ate: P
Zip Code: q� Fax:
Phone No. - 3
Address:
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City: �� �• ` �I
Zip Code: � I
Phone No 4�P
crne-e Stater
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E-Mail: �{
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Fill in fee simple Tit a Holder on next page (If different
from the Owner listed above)
E-Mail 11Q
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State or County
eicense C
u •amc VI wnauuumn n pcauu or more, a KRVKUCU Notice Or LOmmencement Is requlrea.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
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!SUPPLEMENTAL CONSTRUCTION LIEN LAW,INFORMATION;
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DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
�D Not Applicable
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Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
%2— Not Applicable
BONDING COMPANY:
Name:
,yNot 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 MA
J RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENT UR PROPERTY. A NOTICE OF COMMEN T BE RECORDED AND
POSTED ON THE JOB RE THE FlRST INSPECTION. IF YOU INT O IN FINANCING, CONSULT
WITH YOUR LENDE TTORNEY BEFORE RECORDING YOUR NO OF C CEMENT."
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Signature ofOwhr s nractorasAgentforOwner
Signature ntr to icense Holder
STATE OF FL IDA
STAT F FLORIDA /
COUNTY OF ii
COUNTY OF_ _ U. !�f �e
The forgoing instru rjent wa acknowledge before me
this � day of l4 i` 20 1 by
The f r oing instru nt was cknowledgef� before me
this r day of r � (� . 20 ( by
�illhP.r4- gncrke
9/)her-1 9ru4'ke
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
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Qla o�'! �✓ /%S
re of Notary I
(Signature of Notary Public- Stater1riNotary
Publlo Steve of Fonda
Commission No. Leure: Bevinaadr�Y�Ibn GG 2e0A76
0912012022"unm
Commission No. a�SNr��.•EWms E Bpyins
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
COUNTER
REVIEW
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DATE
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COMPLETED
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