HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: I!/ ` Permit Number: U
SCANNED
_�; - BY
Y Building Permit Application St. Lucie County
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Commercial Residential
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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P#iOPQSEQ`#}�/IFROUEM/ER#TLOC/1T10N.,.
Address:101� nlaki Dri (r'e
Legal Description:
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Property Tax ID It: -y� [!�_ U Lot No.
Site Plan Name: - Block No.
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Project Name: J-re-
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Setbacks Front Back: Right Side: Left Side:
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dditna wor to e'e orme unclerthispermit-c ec-a apply:
❑
❑HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
❑Electric ❑ Plumbing ❑Sprinklers ❑ Generator ❑ Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
❑Septic
�y Building Height:
Cost of Construction: $ �� /t�Q+� Utilities: Sewer
O �L'ESSEE r.,:.CONTRATOR>,�
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:,
Name
Name:
Address:
ompany:
'
City; State:
Add s:
Zip Code, Fax:`Ihl-rl.l-
City: 1 State:
Code:Fax:
Phone No.
Zip
E-Mail:
Phone No.
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Fill in fee simple TRle Holder on next page (if different
E-Mail:
State or County License:
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER. _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
City:
Zip:.
Phone:
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
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 coRict 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.
&� 4! - A � 4-14 � Z/�,
Signature of Owner/ Agent/ Lessee Si nature of Contractor/License Holder
STATE OF FLORIa STATE OF FLORI ,n^
COUNTY OF �f t I e, COUNTYOF
The for oing instrument was acknowledged before me
this �day of�2,V1Q_ . 20ISby
77T�������.L�1��
(Name of person acknowledging )
(Signature'OVNotary Public- State of Florida )
Personally Known IC .gLPmdyype�ldentification
Type of Identificatio Prq°t6tl191YN;--
*g� Not!ry p��iI�nkf� '�gt�
Commission NO. �Yu C,xn{,ige<IA,... �.:.r of F!%Ma
Revised 07/15/2014
The f r oing instrument was acknowledged before me
this day of `, a eQ!jQ . 20_g by
(Name of person acknowledging )
A(Sighare Notary Public -State o Florida)
Personally Known —A/— OR Produced Identification
Type of IdentificagH#1'1 14
Commission No. A?��. lVs Notary PubI4Se£t*j of
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