HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR -APPLICATION TO BE ACCEPTED 77
Date: — SCANNED Permit Number: I
BY
.i~j St. Lucie County REMWED
Building Permit Application JuN Y 4 26t9
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982 l
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 -IMPROVEMENT LOCATION:
Address:
Legal
PropertyTaxlD#: Lot No.
Site Plan Name: C1 Block No.
Project Name: [ Q r
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF.WORK:
I n� l I � �►�d � ors �hc�-We,2S
CONSTRUCTION INFORMATION:
gaitionaiworKtoDe
❑HVP
❑Electric
errormea
E]
unaertrospermit— cnecKau apply:
Gas Tank Gas Piping _ Shutters ❑ Windows/Doors
[]Sprinklers❑Generator ❑Roof = Roof pitch
❑Plumbing
Total Sq. Ft of Construction: -
Cost of Construction: $ ,)IS q I t�
S Ft. of First Floor: _
Utilities:n Sewer ❑ Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Hdre,
Name:
Address:
Company: r✓
City: State:
Zip Code:_ Fax:
Phone No. — 27
Address: ,
r
City: State. --El I
Zip Code: 2 Fax: S -
Phone No— 2
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
d j -J
or-
_
/1
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
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 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
commepc4ng work or recording your Notice of Commencement.
as A�for Owner
STATE OF FLORIDAfIDA—a i r) 4�. J� r COUNTI STATE YY OF ORI nC1 CCtn DA u Rr'
COUNTY OF 4C
The fppjo,ing instru ent was acknowledgedbefore me
this 6�'dayof �tt� 20by
Name of person making statement
Personally Known __Y_ OR Produced Identification
Type of Identification
Produced
(Signature of Notary P lic-Sta 54 M Notary Public-5tateof Fli
-: Commission W GG 1037,
Commission No. �� is IMyComm. Expires May 10,
REVIEWS
RECEIVED
Rev. 8/2/17
The fp{gRing instr ment was acknowledged before me
this ay of �20 [?by
Name of person making statement
Personally Known _X_ OR Produced Identification
Type of Identification
Produced
re of Notary Pu We -State of Florida)
`TICIATREJ
ion No.
Ndary Public - State
'ay,' •` 1Commission a GG
rL`�EPi�� gComm.Expires Ml
flwded tNaugh Naliaul
FRONT ZONING SUPERVISOR PLANS I VEGETATION SEATURTLE I MANGROVE
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