HomeMy WebLinkAboutBUILDING PERMIT APPLICATION,�
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED "105_ os%q-,
BY Permit Number:
— - St. Lucie Cnnnh/
Planning and Development Services Building Permit Application
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Building and Code Regulation Division E x F�� Ftq�
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2300 Virginia Avenue, Fart Pierce Ft 34982
Phone: (772) 4624553 Fax: (772) 462-1578 Commercial Mp� 25 2017
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PERMIT APPLICATION FOR: �
To Select from dro box click arrow at the encki ifiite dropbox, •County, FL
Address:
Legal Description:
Property Tax ID #: j y7 s• �� 3 . 00 % �-
Site Plan Name:
Project Name:.
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Setbacks Front
I Back:
Right Side: g
Left Side:
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L I Gas Tank UGas Piping
0 Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ fir-/ y .S
Lot No.
Block No.
Shutters ® Windows/Doors
Generator Roof
S Ft, of First Floor: _
Utilities: Sewer ElSeptic
Address:- 1 /�zi, � t- 7)
City: _ ni V� ir, r f GvLr c State: L,:L
Zip Code: 3Ua S7 Fax:
Phone No.
FIII in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Building Height:
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Address: 1 + In 3
City: 10 w �k` C. State:-F—'-- -
ZipCode:35y_I a- Fax: `2_L•I.`35S•4/D5-1
Phone No. 5 L:1- "S� s- . 5 a
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State or County License: �} <
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If value of construction is $2S00 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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
_ Signature of Owner/ Lessee/Agent
STATE OF FLC61OUNTYOFORIp A� COUNTYOFSTATE OF O�fI�� gpnrl.
The forgoing Instrument was acknowledged before me
this day of MCW 20 LLlby
A.
(Name of person acknowledging )
(Signature of Notary Public -State of Florida )
Personally Known OR Prod
Type of Identification Produced
F.F R43(ais8
Commission No.
Revised 07/15/2014
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999966 id M- UOISSI gwo0
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The forgoing Instrument was acknowledged before me
<39\day of. M OIX - 20 /2 by
(Name of person acknowledging)
(Signs re of No ary Py cc- State of Florida )
Personally Known `� OR Produced Identification
N ;i�COkUNG
MY COMMISSION C FF 951059
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REVIEWS
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ZONING
SUPERVISOR
PLANS
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DATE
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INITIALS