HomeMy WebLinkAboutBUILDING PERMTI APPLICATIONAlDatePLICABLE INFO MUST BE COMPLE,_- FOR APPLICATION TO BE ACCEPTED i -- - - --
I J SCANNED Permit Number: ISM. � `
BY
St. Lucie County
Building Permit Application
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 !/ Residential
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Lot No.
Setbacks Front Back: Right Side: Left Side:
_Mechanical
Gas Tank
_ Gas Piping
Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:
Cost of Construction: $ Roo•od
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OWNER LE SEE:
OW LL I CM70R;
Name baln�
Name: <J
Address:
Company
City: - State:
Zip Code jv(Z_ Fax:
Phone No.
' Addre"ss:61f4o A11%A%u1* �1+
City: d State.^TG¢
Zip Code: Fax:
Phone No �^
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License `�elk 12D
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
MU LEMEN7 L CONS
-ION IENI
O ;
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 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 restricCor 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 recoFdins vole Notice of Commencement.
Signat Own / L e/Agent
Sig atur f coptr6ctorkiceDiierHolder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20_ by
this day of 20 by
t .
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- State of Florida)
(Signature of Notary Publi ate of Florida )
Personally Known uced Identification
Personally Known _ ce tification
Type of Identification
�o..0.Y8,e
Type of Identification �=
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Produced _ • OAWN AA.
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Commission No. ?'F a>b` • OIxvires h;arZZ
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Commission No. �_ °nued7na� ar�z
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REVIEWS
FRONT
ZONING
04
SUPERVIS R PLANS
VEGETATION
SEATURTLE
MANGRTME
COUNTER
REVIEW
REVIEW RE IE
REVIEW
REVIEW
REVIEW
DATE
9/
RECEIVED
/5
DATE
9
COMPLETED
Rev.7/2014