HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE (:%:n4iPLETED FOR APPLICATION TO BE ACCEI' 'i
Date: SCABNNED permit Number:
-- St. Lucie County
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Building Permit ApplicationApplication�VN Q e
Planning and Development Services
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Building and Code Regulation Division a ���`�g`oeVa V
2300 Virginia Avenue, Fort Pierce FL 34982 St.
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID#: 4q,2,1o' DQoa• nooc? Lot No.
Site Plan Name: Block No.
Project Name: 4-1, 0)
Setbacks Front Back: RIA/ht Side: Left Side
Mechanical _ Gas Tank _ Gas Piping _ Shutter _ Windows/Doors
Electric _ Plumbing _ Sprinklers ' _ Gene for _ Roof Pitch
Total Sq. Ft of Construction: 1 ��— Sq. Ft. of First Floor:
Cost of Construction: $ 21 3 S O iX Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name c( X1004�`
Name:
Address:_ /32,VU 16fBouaa R1,06c 131-✓Q
Company:
City: e-,=z State:
Zip Code: 36f f419 Fax:
PhoneNo.�20 953— 5Z9Q
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail: )efi✓/fR u id q ✓ Zt I , GJh--
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 LIEN LAW INFORMATION:
DESIGNER/ENGINEER: ,�ot Applicable
Name:
MORTGAGE COMPANY:,
-Name:
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:.
,FEE SIMPLETITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
�dVot 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. 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, screeh rooms and accessoryuses 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 wo' or recording your Notice of Commencement.
T
Sig ature Owner/ s / ontractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF -S,•Q•.0 i.r a ,
COUNTY OF
The forgoing instr ent was acknowledge rl before me
The forgoing instrument was acknowledged before me
this_ day o1 f 20 ``� by
this _ day of . 20_ by
(Name of person �a mowledging)p=e
//_ O'000U12
(Name of person acknowledging)
(' nat re of Notary Public • tate cf,Elorida:).
(Signature of Notary Public- State of Florida )
a LASHAHNAINGRAM
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Personally Known eod'ueetl itlenttf�icatlBhFlorida
Type of Identificatio = 4 + _ P,ty Comm. Expires Dec 2 ,
Produced y'ix' ac Commission 7F FF 177249
Personally Known OR Produced Identification
Type of Identification
Produced
,������• o . ough National Notary Assn.
Commission No. v (Seal)
Commission No. (Seal)
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RECEIVED
DATE
COMPLETED
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