HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
SCANNED and -
BY Permit Number:
St. Lucie County
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line I
Address: 21c2cn tfvi d/d `m27- Pieae2/P/ ®� �
Legal Description: �G �'/�� ��/�c c!�L ✓`�� r;�/ Agi�'o e�_ 0
Property Tax ID #: %/ a —3 — — (no® —'0 D o — 0 Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF, WORK:
CONSTRUCTION INFORMATION.
Block No.
onai work do oe
HVAC
Electric
errorrueo
unuer uns
Gas Tank ❑Gas
Plumbing []Sprinklers
perrnn—LneLK au dppry:
Piping _Shutters ❑
❑ Generator ❑
Windows/Doors
Roof ❑
El
Total Sq. Ft of Construction:
Cost of Construction: $ ,"� any,
St�Ft.I of First Floor: _
Utilities: LJSewer ❑Septic
Building Height:
Roof pitch
OWNER/LESSEES
CONTRACTOR:
NameOCe,f�✓1f7,0130(2- revs ®D ✓
Name:
L
Address: 'F) ;'�S T�l.4.�P
CoCompany: 6T�rlG� �//'; --�m
City: /i/i20 �Jlifr � State: �G
Zip Code: 3 d Fax:
Phone No. 7 -7a — 7 gam_ !
Address: 4
City: ':5>4g� /¢Ys 43 Z—iy State: `G
Zip Code: 3 Y F 3 Fax:
Phone No. —% 31
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: 67yGTu2�oN �L ��%✓/
State or County License:,--'
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER: _ Not Applicable
/ PP
Name:/)i14
MORTGAGE COMPANY: Not Applicable
_
Name:
Address: d O 7r`` f}vli
Address:
City: C/,? GZU G State: _
Zip: Phone 97. 7 —1A.57
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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
commencing work or recording;giitr Notice of Commencem"t. /%
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA� 7
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STATE OF FLORIDA
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COUNTY OF
COUNTY OF Gt'N_
The oing instrui a tt y(� acknowledged efore me
Thefng instrur��ept��g ac�kn9wledg� efore me
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this day of Ca'U1 20 _ by
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Name of pers making statement
Name of erso aking statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
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My COMMISSION #FFI327 g
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EXPIRES September
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EXPIRES September 28, 2018
28, 2018
(407) 39e-0153
(;07)39M153 Florldallotarysemice.com
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Rev. 8/2/17