HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONf 1 —
All APPLICABLE INFO MUST BE COMPLEti cu FOR APPLICATION TO BE ACCEPTED
Date: \ OT) \16\ SCANNED Permit Number:
_ BY
St. Lucie CwrW
Building Permit
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: Sn� o K !'
Address: nM 1 j (1
Legal Description: Ho 1 I
Property Tax IC
Site Plan Name
Project Name:
Setbacks Fr
Fro
Back: Right Side: Left Side:
_Mechanical _Gas Tank _Gas Piping _Shutters
_Electric _Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction:
Cost of Construction:', Li
Residential
Sq. Ft. of First Floor: _
Utilities: _Sewer _Septic
Windows/Doors
Roof Pitch
Building Height:
01IVNER�/.,I E3SEE,
GONTRy LIMT
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Name
Name:
Address-
City: ''r''`` )
Zip Cod • �i 5 �I Fax:
Phone No. 11 �, (�
Stat
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Compan
Address:
q
City.
Zip Co e: Fax:
Phone No a S
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
Q d ( .
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL,CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 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.
Signature of Owner/ Lessee/Contracto as ent for Owner
Signature of Contractor/License Hold
STATE OF FLORID` 1 ��
COUNTY OF 1.
STATE OF RWaL
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COUNTY OF—
The fo oing mstr m t was acknowledg efore me
thisday Of 20�by
Th rgc ing instr e w s acknowled efore me
thi� day of. 20LI
Name of pe son making statement
Name of person making statement
z
Personally Known OR Produced Identification
Personally Known k4d_�) OR Produced Identifi tit 5Z
Type of Identification
Type of Identification
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Produced
Produced
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Rev.8/2/17