HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
BY
St. Lucie County RECEED
Building Permit Application m 241 IM
Planning and Development Services
Building and Code Regulation Division Mi: i i iNG
2300 Virginia Avenue, Fort Pierce FL 34982 6L BiruiivCscwnty,, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial �_ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
.PRnPOSED�IIVIPROVEMENT`.LOCATION:• �- '. ' � �. » � ,.. � �-`:A•`z
Address: /(
Legal Description:
Property Tax ID #: }1�
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Q Lot No.
Block No.
9S
CCSY� C�N i Y Ti✓1 o�2Q I� mil /lam 63;% l c%1 191-eaO.. Z,4i/:e�-
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CONSTRUCTION INFORMATIONS ` # r.',III
UHVAC L.J Gas Tank UGas Piping LJ Shutters
11 Electric 0 Plumbing Sprinklers 11 Generator
Total Sq. Ft of Construction: ,f+ 5 Ft. of First Floor:
Cost of Construction: $ Z b �Q • OV Utilities: Sewer Septic
❑ Windows/Doors
Roof
Building Height:
OWNER%LESSEE
CONTRACTOR`
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Name 1'j&�,17 CA6
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Name: _LI
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Address:, Z06A'7 SL"�6r�p �
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Zip Cod -1 Fax:
Phone No.
Stater
Address:
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City: S� U�} L>2-_ State:_r__C_
Zip Code: 31p 9�(� Fax:�3Z 7$i=
Phone No. �% , t> 2- — 312rl?
E-Mail: ZS CP-"/ , i96L-- CDM,
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: J06,?�
State or County License: r
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If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Name: G 5
City:
Zip:.
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: r 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
rnmmanrine work or recording vour Notice of Commencement.
_ Signature of Owner/ Lessee/Agent
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of 20 _by
1
(Name of person acknowledging )
s
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of . 20 _by
of person acknowledging )
(Signature of Notary Public -State of Florida) I (Signature of Notary Public -State of Florida
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced I Type of Identification Produced
Commission No.
Revised 07/15/2014
(Seal)
Commission No.
(Seal)
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIE
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
COMPLETE
INITIALS