HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: 1 / 0 1- UnI03
SCANNED
BY
Building Permit Application St. Lucie county
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 )(
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address:
Property Tax ID #:
Site Plan Name: _
Project Name: i
Setbacks Front Back:
Right Side: Left Side:
.DETAILED DESCRIPTION OF WORK;
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L jHVAC L:_I Gas Tank UGas
11 Electric 0 Plumbing �Spr
Total Sq. Ft of Construction:
Cost of Construction: $ C27�. om
Piping
Lot No.
Block No.
app y. _
Shutters ❑ Windows/Doors
Generator Roof = Roof pitch
S Ft. of First Floor:
Utilities. Sewer E]Septic Building Height:
"OWNER/LESSEE:
CONTRACTOR:
Name
Name:
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hnn
Address:
Company:
City: State:,
Zip Code: Fax:
Phone No.
Address:
City: rStt 1a�t�e:
Zip Code: Fax: _)•�
Phone No
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail. ��M I ��2W�TI
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State or County License: Li 1e I 7.7pa
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
.Su
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CONSTRUCTION',
LAW INFORMATION:' -
able MORTG GE COMPANY: _ t Applicable
1 Name:
Address
tee L City: _ State:
FEE SIMPLE TITLEHOLDER: of Applicable BONDING COMPANY:IL-Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: _ Phone:'`- Ti Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Counttflflyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
ssttructture. Please consult nwth your Hlome Ownn rsAssociation and review your deed for any restric Ions whirestrict
h may aplprohibit such
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
STATE OF FLORIDA1"1f
COUNTY OF
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Sign"ContractotrlenleHoler4M!�
STATE OF FLORIDA
COUNTY OF
The fo oing instrument was acknowledged before me The far oing instru ent was acknowledged_before me
this-Ndayof C . 20 Jqy this for yof �li 201F'_by
ch[11 W]51in ok,nn.0(`c�vCali 0
(Name of person nfa knowledgmg) ame of person acknowled ' )
(SIgnaturEVotiN PublIgIrState of Florida)
Personally Known OR Produced 1 entification
Type of identification Produced
Commission
HOLLY BURGESS
Signatu &en ry� /u'� State of Florida )
Personally Known `L/ OR Produced Identification
Type of Identification Produced
Commission No.E 19 (Seal)
. o ; umm - amr° m r uuuu '.4•^.. tea. II
Commission # FF 211412 , Notary Puhlic -Slate of Florl a
Revised 07/15/2014 i y • 0,3 My Comm. Expires Mar 18, 2019 Commission # FF 211412
REVIEWS
FRONT
COUNTER
NS
REVIEW
�
VEGET
REVIEW
REVIEW
N sn.
REVIEW
ZONING
REVIEW
SUPERVIS R
REVIEW
DATE
COMPLETE
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INITIALS