HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I'o2� I(% SCANNED Permit Number:
BY
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:
Address
Legal Description:
Property Tax ID #: LP " OI ► l — IMw " I Lot No. LI• -b 5
Site Plan Name: Block No. 3 _
Project Name:
Setbacks Front Back: I S E' Right Side: kd T LeftSide:
_Mechanical _ Gas Tank _ Gas Piping _Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Lori to Sq. Ft. of First Floor: U96
Cost of Construction: $ i 410�� Utilities: —Sewer _Septic Building Height: 1 �i
OWNER/LESSEE:
CONTRACTOR:
Name Ct�o� "O-z lyta:
Name:
Address: 18N, so-n- a A8'
1G_Jpyyw
Company`: ='
City: VpC'-k Rec-c'e.
Zip Code: 3495 1 Fax:
Phone No. (q -) 519—aar1
State:Fl.
1rJ713 ;,r,
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: r I
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION 11M EN I LMWJ IN
EOREJU&M
DESIGNER/ENGINEER: _Not Applicable .a
Name:
'MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:'
City: State:
Zip: Phone
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,irooms and accessory uses tdan`other 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 your Notice of Commencement.
Signature of Owner/ Lessee/Con ctor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Sjr,)
COUNTY OF
The forPoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this a lday of 20n by
zna
this day of 20_ by
Name of person making statertbrit. U
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced 2FAL fL
Produced
igna re of Nota . P blic- glate of Florida)
(Signature of Notary Public -State of Florida )
ror�r�n.,, LAS I
Commission No. o� o&� NtjlWl
_ Notary P is - State of Florida
Commission No. (Seal)
My Comm. Expires Dec 20, 201E
9t Op pl
� i.
it _-.
REVIEWS
NT
ZONING-.;:-
SUPER�I R
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8j2/1/