HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 'L N \5 SCANNED Permit Number:
�
-- -- - BY
St. Lucie County cFiG
Building Permit Application OAF
Planning and Development Services B
Building and Code Regulation Division jrP?
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial I/ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line <'Z,, III
POSED IMPROVEMENT
Address:
Legal Description:
u
Property Tax ID #: / �/_ - 5e /:VFJ 5F- 3'j'6 9 Lot No.
Site Plan Name: Block No.
Project Name: uM
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: III
0 1,x <'
I CONSTRUCTION INFORMATION: III
❑ HVAC ❑ Gas Tank
11 Electric ❑ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
-as Piping ❑Shutters ❑ Windows/Doors
Sprinklers ❑ Generator Roof
S Ft. of First Floor: _
Utilities:ll Sewer ❑ Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name G
Name
Address, o / �o �J
��q.
O //i& Of
Company
o. C°
City: State:
Zip Code:'% Fax:
Phone No.
Address: � /
79 '
City: ep_
Zip Code: 4/ Fax:
Phone No. -7 7 ?
State:-
1,5
/
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: S7 / G Al 5 o
C.- cc`%� , /U'
State or County License:
-6-0 es
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNE GI r ER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ NVpplicable
C
Address:
Address:
/iN
City:
Zip: Phone: f—S��'�/
te:,._
— 3Y/
City:
Zip: Phone:
Stw.
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable 10
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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_ vour Notice of Commencement.
_ Signat r
of Owner/ Lesse Agen Signature T
Contractor/ cense Holder
STATE OF FLORIDA ZJ STATE OF FLORID
COUNTY OF d. 0 COUNTY OF
The fLgping inst entyyrrl was acknowledgeefore me
this ay of C� 20 by
�ers�na OR Produced Identification
Notary Public State of Florida_ I)
i�ae L Lamb �>��
My Commission EE 159114
Revised 07/15/2014
The forgping instrument was acknowledged t efore me
this)' ddayof S-C,' .20 by
(N of person acknowledging)
- )/\Oa 0 4u_�
(Sig-ITAure of NotaryPublic-State of Florida (
Jy_Snevfn OR Produced Identification
Identification Produced
NetaFy Publie- State -of Florida
Trade L Lamb
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
%J
3 ( I
INITIALS
Name:
City:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
NOT Applicable I MORTGAGE COMPANY: _Not Applicable
Name:
Address:
te: City: State:
—.4Y/2� Zip: Phone:
Not Applicable
BONDING COMPANY:
Name:
Address:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit
_Not Applicable
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 antl 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
"yz
_ Signal a of Owner/ Lesse Agen
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of 20 by
s
Signature Contractor// cense Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of 20 _ by
1
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public -State of Florida) I (Signature of Notary Public- State of Florida)
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. (Seal)
Revised 07/15/2014
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS