HomeMy WebLinkAboutBUILDING PERMIT APPLICATION- a
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1�r� /� ^
Date: SCANNED Permit Number: iIOD`oi -0 fJ
BY
St. Lucie County
a
Building Permit Application P61" , ; a
Planning and Development Services ��Y 9
Building and Code Regulation Division 2016
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Reside tiapERMITTimn
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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i}ROPOSED_)MPROVEMNT„„LOCATION/..
Address: r i V2
Legal Description:
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Property Tax ID #: OV Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:.
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CONSTRUCTION INFORMATION y $;, °... t `*
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,. •'Additional wor-tob e 0 orme un eft is perma—C eC a appy:*14
❑HVAC 13GasTank ❑Gas Piping _Shutters ❑Windows/Doors
11 Electric 1:1 Plumbing Sprinklers 11 Generator Roof
Total Sq. Ft of Construction: �[[,,11 S Ft. of First Floor:
Cost of Construction: $ �` l • 00 Utilities•12 Sewer Septic Building Height:
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Name
Name.
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Company R S S4 I10-
Address: D Gl riefe A
City: - State.
Zip Code: Fax:
Phone No. —
city e- State:
Zip Code: —1 Z Fax_nz - Liro5'B22_1 I
Phone No. ter 0 `�i
E-Mail:
Fill in fee simple Title Holder on nex page if different
E-Mail: r
from the Owner listed above)
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: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City: _
Zip:
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
City:
Zip: Phone:
State:
BONDING COMPANY:
Name:
_Not Applicable
Address:
City:
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
Lessee
STATE OF FLORIDA I
COUNTY OF S
The for oing instrum t was acknowledged efore me
thisdayof 20Mby
(Name of person acknowledging )
(Signatufo3f Notaryy Public- State of Florida )
Personally Known V OR Produced Identification
Type of Identification Produced
Commission No. �4 (Seal)
n, . RAOL14 BROWN
Revised 07/ /, o .° ,- Notary public -state of Florid a
• .., n..,., c.nbs Mar 19. 2011
Holder
STATE OF FLORID
COUNTY OF UC,
The forgoing instru ent was acknowledged before me
this day of , 20�by
person
(Signatur,J'Notary Public- State of Florida
`)
Personally Known ,-/ OR Produced Identification
Type of Identification Produced Commission No�16 (Seal)
Notary Public - StMa of Fla AS
My Comm. Etpiirts Mu 18. 2017
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