HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONN
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �— p
Date: �V' Ld/—�g Permit Number:zlY"1 I`�A �/ l✓I
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Building Permit Application �o d�
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 x
Phone:(772)462-1553 Fax:(772)462-1578 _Commercial Residential
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal Description:
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50— a(zlW
PropertyTax ID #: Lot No.
Site Plan Name: .� Block No.
Project Name:— GhQ" CS 11W Go eS
Setbacks Front Back:
Solar Clec..
Right Side: Left Side:
SCANNED
E3Y
St. Lucie Coum
Windows/Doors
Roof
Total Sq. Ft of Construction: r� '1 5 Ft. of First Floor:
.Cost of Construction: $ t�r a3 1.60 Utilities: Sewer OSeptic Building Height:
0�1NNER/LESSEE:000
"CONT�RAGT®R" s«r• ,xk`" ' �'
Name e U—) G '- e5
Name: er�' Zr'q\10�
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Company:9AIaY C—ne_CEN SYS
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City:zcn5c-c) e-c\Ch State:)
Zip Code:—` Q 51 Fax:
Phone No. _1 a— _'�CiQ — 1 a1 Lo
Address: I 0 �r�0.��wcxl� lAV
City: 1 er e e State: �1
Zip Code: -JL 4 9 % a. Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: �l so� Rr ene
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State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _
Name:
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 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 consultwith 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 our Notice of Commencement.
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Signature of Owner/ Leesse /Contractor as Agent for Owner
Signature of Contract-oVfi6ense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOF S-F LQC tC—
COUNTYOF `S1 I �IGiQ
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this_JLdayof201qby
this _L�_day ofOcitnbed 20LRby
r`i?\otea`% %galo'rg_
k��`�e�i %c\�Gdc
Name of person making statement
Name of pers- making statement
Personally Known ✓ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
��II%�
enz (-c JAICO Ste['/�
(S nature of Notary Public - State of Florida)
(IS gnature of Notary Public- StSte of Florida )
Commission No. iZ5 a
�O otary Public Stets of FI
om ssion No. G-Y. 2-q1�
ri a Notary Public Stata of Flc
Made Sarah Slysione
My Commission GG 381
�I Made Sarah Blystone
95 My Commission GG 361:
REVIEWS
FRONT
P S
VEGETATION
I
I R
SE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17