HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABFE NFO 1LIST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �^ "
Date: ' � ,L SCANNED Permit Number:
BY
MUNRO St. Lucie Countv
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 t
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
`PROPOSED IMPROVEMENT COCATIO t;=
Address:." (Oi0
Legal Description:
Property Tax ID #: ,_"1<-A%J0
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
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Lot No.
Block No.
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CONSTRUCTIgN'+INFORMATION �}•
Additional workto be nnerformea un m ert ispertt—c e cK all M appy: _
OHVAC GasTank ❑Gas Piping _Shutters ❑ Windows/Doors
Electric El Plumbing Sprinklers EiGenerator 0 Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ :�Onn .
Sof First Floor:
_
Ft
Sewer Septic
Building Height:
CQNT CTOR. ;
Name
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-Zip Code: l�o� Fax:
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Address: 0 :1— S
City:
Zip Code: `ji�1 0 Fax:
Phone No. -Ui-- 06
State
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E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: L)0lTf DJZL rGGLJ t
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State or County License: G
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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:
Name:
Address:
Address:
City: State:
City:
State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
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
commencine work or recordine vour Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of 20 _by
(Name of person acknowledging )
(Signature of Notary Public- State of Florida )
Personally Known
Type of Identification
Commission No.
Revised 07/15/2014
OR Produced Identification
(Seal)
Signature
STATE OF FLORIDA
COUNTY OF
The
this
acknowledging)
me
of Notary Public- State of Floriba )
Known 1 OR Produced Identification
Type of
Commission No.
VANESSA RIVERA
EXPIRES:April 17,2020
Bonded Thm Notary Public Underwriters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
fSUPP1 EMEIVTAL CONSTR17CT10N LLENIJ�1lV
IIV1
ORMA10lU
? z v { ` u._ n xx
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: _
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone:
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not
Name:
Applicable
Address:
Address:
City:
City:
Zip: Phone:
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
commencing work or recording vour Notice of Commencement. n
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF :6i La Cie. COUNTY OF
The forgoing instrument was acknowledged before me The r a Qns*mntwastackle(
thisdayof d jM . 20 /aby this • day of2
I(Me-y t�P �-Y► Att�� ttJ i
(Name of person acknowi ging )- (N e o person acknowledging) t
Public- State
Personally Known OR
Type of Identification Produces
Notary
Produced
by
meLL
Commission No. '2aCOCOLE M. Q OfB sion No.t6
.�«A0 �'� my ¢ WA>
EXPIRES* Match i]r".•". -''po c Put6eVt�
U t
Revised 07/15/2014 -
a' 9
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
/
COMPLETE
J _I
INITIALS
C