HomeMy WebLinkAboutBUILDING PERMIT APLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED —
Date: 41 III- SCANNED Permit Number:
BY
St. Lucie Countv A;unoD al�nj IS
Building Permit Application A
Planning and Development Services OBNNVJS
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
i-PRGPGSED IMPROVEMENT LOCATION: .° -
Address: -3j'«
Legal Description:
Property Tax ID #: 3uaa fQ to Ii017 � ((? Lot No.
Site Plan Name: Block No.
Project Name: 14 1 urrr
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: .11 ,.
Ch4\N I,w IL: ctgPQAY,
CONSTRUCTIOWINFORMATION:
AaclitionalworKICIEleaericirmed un ert ispermit-c ec a appy:
EIHVAC Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
❑Electric 0Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: 4 '30 S Ft. of First Floor:
Cost of Construction: $ Url,01TO O Utilities: _ Sewer ESeptic Building Height: L
OWNER/LESSEE:
CONTRACTOR:
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Name:
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Company:
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Zip Code• ZlD Fax:
Phone No Sb 39Z1
Address: S
City: State:l��
Zip Cocl(ZN1 4-Fax:
Phone No. a--ja D--) %3
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: P orw?. s RZ ('i
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State or County License: % U?- LOZ C�Gr
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Name:
Addre:
City: _
Zip: _
e:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City:
Zip:
:.nT4
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 Countyyimakes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contict 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
A L I-
ictor as ARE
STATE OI
COUNTY
The forgoing instrument was acknowledged before me
WAS=` day of �-v'-'Q' 20 Q_-by
Y—
(Nammee of person acknowledging)
(Signature of Notar ubli - State of Florida )
Personally Known OR Pk`oduced identification
Type of Identification Pro
NOTARYPUBUC
Commission F FLOF[lbliiiI)
Cwyaq GG049730
Revised-07/15/2014
s
Signature of ontractor/License Holder
STATE OF FLORIDA
COUNTY OF
hr7
The forgoing instrument was acknowledged before me
this day of ALA, -L- 20 L7_ by
(Name of pe�rson� acknowledging )
(Signature of Notary Pipit- ate of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Ysams
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Commission OTARYpUSUC (Seal)
ae = STATE OF FLORIDA
Expires 11/22/2020
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