HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -t
Date:? 11 I SCANNED Permit Number:
BY RECEIVED
N St. Lucie Countli
Building Permit Application JUL 1 0 '01
8
Planning and Development Services ST. Lucie County, Permit]ng
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Re a.nv&A'A Y" I
Address:
Legal Description:
Property Tax ID #:
Site Plan Name: i
Project Name: \\1
Setbacks Front Back: Right Side: Left Side:
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Lot No.
Block No.
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❑ Windows/Doors
0 Roof
Total Sq. Ft of Construction: S'c Ft. of First Floor:
Cost of Construction:$ iQS14000.D(J Utilities- Sewer ESeptic Building Height:
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Name U
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Name: rlK RUSSO
Address: / 414
Company: FOMIIV Qy/S'
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Zip Code: Fax:
Phone No.365
State
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Zip Code: c3y4 g3 Fax:_1U
Phone No. %7,2 kq_c;a..
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E-Mail: NDOC / S 44—
Fill in fee simple Title4older on next page ( if different
from the Owner listed above)
E-Mail: A[1010
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State or County License: I
55& 24a
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:
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Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
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BONDING COMPANY:
Not Applicable
Name:
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 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
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Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA COUNTYOF : R Lucie.
The f going instru a was acknowledg efore me
this I day of UIA I Q 20M by
Name of person ma i g statement
Personally Known OR Produced Identification
Type of Identification
Produced
/ ol& -00t
(Signature of Notary Public- Stage of Florida )
Commission No..
,
-p;�>"ir°�e;'�._ StateNI
# FF
REVIEWS
:fxla►ri4DA
COMPLETED
Rev.8/2/17
Signature of Contractor/License Holder
STATE OF FLORIDA f, COUNTY OF UU !�I
The f oing instrum t as acknowledgppefore me
this day of k 20_ by
Name of person makin tement
Personally Known GW15roduced Identification
Type of Identification
Produced
(Signature of Notary Public- Sfhte of Florida )
No. (Seal)
MANGROVE
REVIEW