HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLI ABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: (�yll
Building Permit Application SCANNED
Planning and Development Services BY
St. Lucie CountyBuilding and Code Regulation Division
2300Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential _
PERMIT APPLICATION FOR:
To Select from dropbox, click arrow at the end of line
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Address:
Legal Description:
Property Tax ID if: 11411,4 —7 0 I — n I w) — noo -Izz Lot No. A
Site Plan Name: Block No. I Lo
Project Name: —
Setbacks Front Back: Right Side: Left Side:
I�itm�u� ,5 fcxis-���,� LP `�ank QP��aciv� Lt9i�� L9er.a—T,; L
(126 54,1,1 \) 11
�MUILIUJIQI VVU1A w U el IUI IIICU UI Wel Lnn Pei lll[L—cnecK all apply:
DHVP _Gas Tank []Gas Piping _Shutters ❑Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ ca7 Ci W ,nUtilities:cnSewer OSeptic Building Height:
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RA�1OR
Name
Name: CbM49 nrw
Address: )to fraf(r'pt .r1 hsS4.
Company:Fli G Co
City:RLdir%,hs&^ Tla 9nd state:1E
Address: I9
Zip Code:3gl!4q Fax:
city— % tj'State.
Phone No. t iiai Bag- 046S
Zip Code: -nigq C — Faxt?72). I Ss xi
Phone No. (773, :)2 —oil o-7 R
E-Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail: lr—&A
State or County License: 113(21
from the Owner listed above)
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
UFPLEMEP7AL GONSTl2U , I,ON L! N L'AW=INFOFtMAT10N'
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DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signat re of Co ractor/License Holder
Sign t of O ner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
STATE OF FLORDQA
COUNTYOF�AC7✓'f n
COUNTYOF VIAYii✓�
The forgoing instrument �was ��a��cknowledged before me
this day of 20� by
The foQrggoing instrum t was acknowledged before me
this OCLPday of 20,� by
C'
Name erson making statement.
Name of person making atement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signatur o of ry_ u II - t t I�JS
�Qopry41'y fate of Floritle
(Signat re o Nota u c- e o I
Notary u is to of Florida
siree N McIntosh
,rp
a9 McIntosh
Commission No. Cotnnlmoegd$ 283399
Commission No. � 2833aa
or Aires 12/112022
�Jopiffis
4 w 1120
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 277/19