HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR_. APPLICATION TO BE ACCEPTED t�q
Date:
BY
St. Lucie COunty
RECEIVED
-— Building Permit Application APR 24 2019
Planning and Development Services rermitting Department
Building and Code Regulation Division St. Lucie county
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1575 ' Commercial Residential
PERMIT APPLICATION FOR:
Address:
Legal Description: 4,F r5 r G 7
Property Tax lb #: _ tl d ,� - d o 3 ' O d 1 , C>o Lot No.0/ c
Site Plan Name:
Project Name:_
Setbacks Front 112 Back: $S Right Side: 1 LeftSide: ,�OGI_8
Block No. (—
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 0 o; 0
Cost of Construction: $ /`/ rDae
Sq. Ft. of First Floor: /0'P90
r
Utilities: _Sewer _Septic Building Height:���
OWNER LESSEE n� ° " �r,s ;<
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Name Erg o �(�n
Name:
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Address: Gd/'f/ -7 %S ca('Z,A n a I �f
Company:
City _� I • p ^ rState: ��
Zip Code: 31/ -TLZ, Fax:
Phone No._ %%,,Z Sz S S,2 7 `I
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail:. r),)A X A Ar // Si. lL r-
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License
IT vaiue oT construction is Z5DD or more, a RECORDED Notice of Commencement is required.
5UPP EM€NT GONSTR
= N LIEN LAW INFO
MATfQN:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
✓Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_1Z 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 Countyy 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 your Notice of Commencement.
Signat re of -owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA 1
STATE OF FLORIDA
COUNTY OF 5�,
COUNTY OF
The for oing instru t was acknowI dger before me
The forgoing instrument was acknowledged before me
this day of 201 by
this _ day of . 20_ by
Name of pers mak g statement. \
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Pro ucedft
Produced
(Si nat re I otary Public- State 6Y Florida ) J
(Signature of Notary Public -State of Florida )
Commission No.
INGRpM.RgHMING
ommission No. (Seal)
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