HomeMy WebLinkAboutBUILDING PERMIT APPLICATION;:,ZLLAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED permit Number:
BY
ST LUCIE COUNTY =RECEIVEDBuilding Permit ApplicationPlanning 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 A
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal Description: c�Pry�clSe-)f�-p_uc.eeLn
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zacm OY1 I _ IA"XT T- YTI,
P ro perty Tax I D #: -- Oof. Lot No.
Site Plan Name: /� Block No.
Project Name: N-�.'ieC n �• aC.ps'>�
Setbacks Front Back: Right Side: Left Side:
R-ZP kGc e S l JANT%9 S \CAtO S .100 a LO6h I CA PO-Ct
OHVAC 11 Gas Tank 11 Gas Piping
Electric 0 Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ Ilo i 1 n . Sfo
Shutters ❑ Windows/Doors
Generator Roof = Roof pitch
Sq. Ft. of First Floor: _
Utilities: Sewer Septic
Building Height:
Name �5i-e'iyn (a C't�CoSSA
Name: TQhQ-�Gt
Address: �IOD �. �1t4 QFi n\
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Company: N6A-LxCY: I t pu *i -rnG_
City: Y'(_ C Stater:--
Zip Code: 3`+94`t Fax:
Phone No. q n J� 'ASS 5-B]
Address: -ZCL1 --Nig
City:��-+-t(r,}r v Stater.,
Zip Code: q cl 9 `i' Fax: 33g — I Oi g
Phone No. a kA —
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: Ian P_tC jN
State or`C-ounty License: 5CC Imo( (51 �L b3
o,,.=.. _.,,.I.,.'� ,. -?'.UU U, ,,,ore, a rcewnUeu Nonce or commencement Is required.
SUPPLMf TL CONSTRUC71iJf L IEN I AW INFORiVIAT(f?N
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
_ Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
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 Count 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 vour Notice of Commencement.
Signat re of Own r/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF j'YIlF72 IAI
'The for oing instrument was acknowledged fore me
thisydayof nih- e-ll .20�y
a-Q r%.e / `'%mil % // e /
('Name of person making statement
Perso ly Known _ V OR Produced Identification
Type of Identification
-rigoAtufe of Notary Public- State of Florida )
Commission No. r°`-wrZ@,I) LYNDA_ A_
'++?o'�rv4; EXPIRES Dace
REVIEWS I COUNNT TER TER I RENING VIEW W S REVIEW
COMPLETED
Rev.8/2/17
ignature Contractor/License Holder
S OF FLORIDA
COUNTY OFD4%�ir!/
The for ing instrument was acknowledged fore me
this 7day of JV A/L ch . 20�y
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Notary Public -State
- '— �,
k7? _;., MYCOMMISSI0N#FF1e
(407) �gg,0 ecember a, S
VEGETATION I Ida o V.
REVIEW REVIEW REVI