HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATICIAO BE ACCEPTED
Date: 1 "h—� SCANNED Permit Number:)( —)--
BY . 1 a
St. Lucie County
�o A
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phom (772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
Legal Description:
Building Permit Applicati -
or,_'a
O�
-Commercial Residential_
Site Flan Name: MUCK rvU.
Project Name:
CSetbacks'_F.cont BackN_ Ri htSideT
—Mechanical
— Electric
_ Gas Tank
— Plumbing
Gas Piping
—Sprinklers
Shutters
— Generator
TaSq.'Ft of.C-Y t'ruction: IM 1,242 Sq. Ft. of First Floor:
Windows/Doors
Roof Pitch
CC_d sst b "-^ram' ." h1
Cost ofConstruction. $%, (! V Ut'lities; Sewer Septic Building Height:
t N EMf,LESSEE
CO T AGTOR:
Na a
'Name:,—,?
Address: I 03Sr
Company t
City`. IVC�2 State
Zip Code,, Fax:
Phone No. 7-��,_�ei 3 trio
Address: ,
City: State:_
Zip Code: Fax:
Phone No
-E-Mail:--
r
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.
U €MEN AL CONTT U
ION EN L ' !
FORMATIQN:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
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 norepresentation 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 reviewyourdeed 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, s ' "rig pools, ces, walls, signs, screen rooms and accessory uses to an non-residential use
WARNING TOC�iinspe
NER: our ilu to Record a Notice of Commencement may result in your paying twice for
improvementsour ro rt A Notice of Commencement must be recorded and posted on the jobsite
before the firs o If u intend to obtain financing, consult with lender or an attorney before
commencing o re r nR vour Notice of Commencement.
Signature Owrier ess o ctor as. gent,for Owner
Signature of Contractor/License Holder
STATE OFFIDA' //
STATE OF FLORIDA
COUNTY �f Z D-f-1L
COUNTY OF
The'for' oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of �ue e_ 20� by
(e
this _ day of . 20_ by
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
A
(Signature of Notary Public- Sta otpliN a) MARIAD. GOMEZ
( gnature of Notary Public- State of Florida )
.
1. ;i- Notary Public •State 9l Flo
da
Commission No. s % 'lcommission p GG 29795
GZ �. :,,.orh eQ Comm. Expires Feb 4.22Q
_
mission No. (Seal)'
- - " Bonded through National Notary
ssn.
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