HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLEI w POR APPLICATION TO BE ACCEPTED
Date: 3��T SCANNED Permit Number. yt ro
BY
St. Lucie County ERECEIVED
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Building Permit ApplicPlanning and DevelopmentServices rmitting
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:.
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Legal Description: �%(� (Jn "C 7 Alo �7'l?k2,0
Yoperty'Taz FD 73YaZ—�O OI —ZJ�— Lot No. /%Va
Site Plan Name: K,41,11 �G S Block No. Y
Project Name:
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_Mechanical •_Gas TankGas Piping
Electric
_Plumbing _Sprinklers
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_Shutters _Windows/Doors , -
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
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CQNTRAGTOR
+�ress:
Company: filed anP.�an
[�ty:
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pe/ce State: FL
Code: y`1 Z Fax:
No. I
Address:2-1" Zp
city. Y /�/n[.
Zip Code:
Phone No
Staterone
Fax:
Mails rr
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
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State or County License /%C
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If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
.SUPPLEMEN�T,X` ,6NSTR
ch6N_ 'L 11!AW INFORMATlO�I��
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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 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
of
Signature of Owner/ Lessee/Confractoras/1gent @r Owner ill! g7 t�ir�,RCCobt,5Et S/,License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF SV COUNTY OF S)r• L-Vc•\C
The forgoing instrument was acknowledgSd before me The forgoing instrument was acknowled d before me
this �.1 day of Iris C 20 N by this day of VN4 C 201 by
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(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notaryublic- State of Florida) (Signature of Nota ublic- State of Florida )
Personally Known
Type of Identification
Prndurzd it• 1. DL-
Commission No.
REVIEWS
RECEIVED
OR Produced Identification
FRONT
COUNTER
Personally Known OR Produced Identification
Type of Identification
DE�ANNAfL
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tt5. Commission• 'JdeN"Is_ D:cep{??cU
dedpw " �•'•;t,�,311 ;?°`• BondedTlw Ndary
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ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE
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