HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ri SCANNED Permit Number:
i ,a t T, BY R is @siF o; ".'.'.-u'
St. Lucie Countv
I Building Permit Application DEC 2 8 2417
Planning and Development Services PERNUTTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial x Residential
PERMIT APPLICATION FOR: Window/door
Address: I =A"
Legal Description:
Property Tax ID #: o�'J�q ^ ��- ��\� ���-� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
�DETAILED DESCRIPTION>OF WORK � t 4
I:CONSTROCTION INFORMATION:;
Hamuunai wurK ro ue
�HVAC
Electric
periorrneu
unuer cros perm¢- cnecK an apply:
Gas Tank Gas Piping _Shutters E9w—indows/Doors
Plumbing Sprinklers ElGenerator ❑ Roof Roof pitch
0
Total Sq. Ft of Construction:
Cost of Construction: $
S Ft. of First Floor: _
Utilities: Sewer 0 Septic
Building Height:
OWNER%LESSEE:
vti
CONTRACTOR;
Name -
Name:
AddreCsss:-1,� SlK -
Company:1�1%'�>CzLaX C�G
{s p5L
City: State: 'FL_
Zip Code: 3 PO 0 Fax:
Phone No.
Addresttss�:��i-"" fJlxl atf
pc�� c)t'
City: r O(k S� Ly ciC
Zip Code: -J�� 6Lo Fax:
Phone No. L-\Uo 30
State: �-
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:\cu\V C� QGLrAG G\� '
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION'
,.......
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DESIGNER/ENGINEER: ✓ Not Applicable
Name:
MORTGAGE COMPANY:
Name:
✓ Not Applicable
Address:
Address:
City: State:
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY:
Name:
_Not Applicable
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
commencinz work or recordin¢ vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Si ature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF f� l v cam
COUNTY OF S* Lx�u
The forgoing instrument was acknowledged before me
The for oing instrument was acknowledged before me
this Va day of��r�ipe.� . 20 n by
this 19 day of 20 nby
Name of person making statement
Name of permaking statement
Personally Known ✓ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
— Q
(Signature of Notary Public S�atgof Florida)
(Signature of Notary Publi -State of Florida )
a°.••:erg TiFFANYA.LEE
z��P,.V•�LaLe TIFFANY A. LEE
Commission No. xMY�§i?d4fSI0NRFF101474
Commission No. epI)IYCONMISSIONfFF1f
b, EXPIRES: Apol 26, 2018
f EXPIRES: April 26, 2(
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++�OFFtioh`O BondedThru Budeel NohryServi:es
a°e BenCtdTtru 6uugt7:c3ryS'.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17