HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COM. .:.'ED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Legal Description:
Permit Number: Kpt0 - (DI-71
SCANNED
BY
St. Lucie Countv
Building Permit Application
Commercial � Residential
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks FrontA14 Back: A,), F Right Side: -" Left Side: _
_Mechanical _ Gas Tank —'Gas Piping _Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:
Cost of Construction: $ //9_naC2
Sq. Ft. of First Floor:
Utilities: Sewer _Septic Building Height:
b`r" ELESSEE;
CONT,ACTORj:
Name
Name:
Company:_ ex Go.r/5'7' iiGTla
Address:7,VrJd f—S aL 4 f/
City: x&wedr State: L
Zip Code:3 $2- Fax:
Phone No. 59 z - 2 L/D -!y I Fy
Address:_.` 2;j" LiA.!!
City: Jp E- State:�l
Zip Code: alyUr2 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 ,�,S C -;:;i 2
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTrAL GONSTRU
N LIE LAW INFORM-7ATION:
DESIGNER/ENGINEER: _
Name: � vzz -t �c�//�i?A
Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: hone:
State:
FEE SIMPLE TITLE HOLDER: _
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 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. _
as
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S�c1v. c _ COUNTY OF — _V �— _
The forgoing instrument was acknowledged before me
this 1i day of Ck-$ 201(o by
Jt.or
(Name of person acknowledging)
&2�� 1 . —
gnature of Notary Public-S to of Florida )
Personally Known OR Produced Identification
Type of Identifcation
Prodly\dl� •:-)
Commission No.
I'MAJI111TO
RECEIVED
(Seal)
in kaO�; AW
The forgoing instrument was acknowledged before me
this jLVday of (icL 20% by
(Name of person acknowledging)
1 �y�
(Signature of Notary Public- St of Florida )
Personally Known _
Type of Identification
Commission No.
PLANS I VEGETATION
EVIE,W REVIEW '
OR Produced Identification \
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