HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED V✓( M/
Date: LP --I— \.q SCANNED Permit Number:
BY
- n 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 _`G Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED-IMPROVEMENT'LOCATION:: -
Address:��
Legal Description:
Property Tax ID #: IL12-q- SD ( Q �0 • of No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
d.C;4� xl�7 s-
CONSTRUCTIONINFORMATION: _
r{omaonai worKLo oe errormea
11
Gas Tank
unoerinis perm¢—cnecK au
[]Gas Piping
apply:
Shutters
_
_
11
Electric
0
Plumbing
Sprinklers
11 Generator
Total Sq. Ft of Construction:
Cost of Construction: $
S Ft. of First Floor: _
Utilities: Sewer []Septic
ED-w--indows/Doors
E] Roof = Roof pitch
Building Height:
`;OWNER/LESSEE: "r �'.
CONTRACTOR:
Name � DI3t'�j o
S n
Address:_ Po f3oo(_ d 7f
City: \ State:
Zip Code: Fax:
Phone No —rJ�3-SSBGi C=4 Is-)g
Name:
Company:�� r Q'2�rS
Address:ll,I]S
City: �T S+ L.lL6e— state:
Zip Code:2yq?Lo Fax:
Phone No.—7-7alLlImo- (03�
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-MaiI:—J�R�'AV c) M ct�t�ac�d�rspsl,
State or County License: Cl`7
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
5UPPlMEiVTAtCONSTRUCf10N CtEN.LAW INFORM..ATION
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DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
_6' qt Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
kPNot 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. LucieCounty 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 our Notice of Commencement.
JC�i c
SignaCam, ���
ture of Owner/ Lessee/Contractor as Agent for Owner
Si nature of Contractor/License Holder
STATE OF FLO Rl_DA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of _`jL>fyC_ 2i 81by
this day of _ S U (1G 20� by
Name of person making statement
Name of pers5pmaking statement
Personally Known ✓ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
IzMC�
(Signature of Notary Publ c- S l :o�_Vrida) TIFFANY
(Signature of Notary Public State c fP da) TIFFANY SUIT
Co*nlsaiarr # GG 191421
r° ••"'•• " CommisslanitGG191421
Commission No.�^�,r ( 26,2922
Commission No. *',V4Sea*pITesMA26,2M
°ate
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
t
Ig O
DATE
COMPLETED
_
Rev.8/2/17