HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number: I �� �' 001(_1.:,
BY
St. Lucie County RECEIVED
Building Permit Application jAH05VIII
Planning and Development Services
Building and Code Regulation Division permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie County
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line .
PROPOSED IMPROVEMENTLOCATION';
Address: ' Ov Lee—, FL
Legal Description:
Property Tax ID#: 341 4 SDI• lgl(0' wort Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED,DESCRIPTIOWOF_WORK
CONSTRUCTION]lNFORMATION:: a,
Adclitional work toI orme un ert —Checkispermit a apply:
❑HVAC lJ Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric OPlumbing []Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ au J Utilities* Ft
D Septic Building Height:
3
'OWNER/LESSEE`.' -:
CONTRACTOR:
Name WC-ele VqqCV10
Name:
it a
0
Address: A7&P SV
Company:
UUlglle
City:loct+ SF lyc+r F• Stater
Zip Code:Fax:
Phone No. 77 —'Fkr gIr/(f
Address:
-T'0 10
'r
City:
Zip Code:
Phone No.
i Q .�4
3361,0
30✓ 0°03
State: FZ
Fax: 304'�3d C� oat
26 2�1
E-MaiL• (gait„t. Wo ha'fN+S i 1,
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
! f 9 0 Ad
/ @ o%rv, co.
State or C unt License: ANJ C%
If value of construction is 52500 or more, a RECORDED Notice of Commencement is requires.
s1�
StJPPLEMENTAGCONSTRUCTION LINI'AW INFORMATION
,
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City:
Zip: Phone •
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
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
rnmmencine wnrk or rerordine vour Notice of Commencement. �) I
Siimdfur o r/l�ee/Contractor as Agent for Owner
Signatur a se Holder
STATE OF FLORIDA \
COUNTY OF S� iuu�n
STATE OF FLOR DA
COUNTYCIF
'//� n��i
1 ' ✓" v
The rgoin ginstr ent was acknowledged before me
hi day of 20 b
Th brinst i nt was
thi day of ..rr �
�(,i'-i LZ A-40Z7-
a cnowledggd before me
�7.en-20 vby
Nam6U person makin statement
Personally Known OR Produced Identification
Name of person_px6ngAatement
Pe on; Ily Known OR P duced i4gritification
Type of Identification
Ty e o Identification
duced
Pr du d
Ignature of Notary Public- to of Florida )
(ign ture of Notary Public-
tate of Florida )
Commission No. (Seal)
Co is!i a r,..'..,,,. RN ea
�. COON#FF 95
t !• EXPIREShp-IT. 2a20
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS VEGETATI
GROVE
COUNTER
REVIEW
REVIEW
REVIEW REVIEW
REVIEW
REVIEW
DATE
RECEIVED
O`
DATE
COMPLETED
Rev.8/2/17