HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number: 1 �f
BY
St. Lucie County
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Building Permit Application
Planning and Development Services
Building and Code Regulation. Division ryPC
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Legal
Property Tax lD #:
Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
�.�� YJ � tic.. .�.:nr.• . .
[HVAC U Gas Tank
Electric Plumbing
IR
shutters [ Windows/Doors
Generator E] Roof [ Roof pitch
Total Sq. Ft. of Construction: S'C Ft. of First Floor.-
1 oa
Cost of construction: S 1.1C�U Utilities-. Sewer U Septic Building Height:
XXlc
Name k_
Add s: o� li C 1
Name: Tosnn
Company: Spt
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City. - - st e:. `.
Zip Code: 0 Fax:
Phone No. —
Address:�0
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City: OC
Zip Codes
Phone No./'
G r State: i
a ty Fax:
C�i.
E-Mail:
Fill in fee simpt Itle Holder an next page (if different
from the Owner listed above)
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State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPRCEMENTALCONSTRUCTIOtV UENgW1N iNFORMATfOlV
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DESIGNER/ENGINEER: _Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City: State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
Address:
Address:
City:
city -
Zip: _ Phone:
Zip: Phone:
OWNER/ CONTRACTOR'AFFIDVIT: Application is hereby, made to obtain a permit to do the work and installation as indicated.
1 certify that no work or installation has commenced prior to the issuance of a permit.
In consideration of the granting of this requested. permit, Cdo hereby agree that Iwill, in all respects, perform the work
inaccordance with the approved plans, the Florida Building. Codes and St. Lucie County Amendments.
The following building permit applications' are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing; consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
ureo /'Ldsgiet7Contractor as Agent for Owner
Si6nat>f of Contractor/License Holder
STATE OF FLOR
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STATE OF FLO 1pA\
t•LUCIQ
000NTYOF
COUNTY OF
The f{Y$oing mstWnent was acknowledged&fore me
this IF 2601Lby
The fpfgoing in ent was; acknowledge before me
this VLO f 20 by
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_Salon 1-1n�erc�Ct--�
Name of persog making statement
Name of Pe s n making statement
Personally Known \/ OR Produced Identification._.
Personally Known a OR Produced Identification
Typ f Identification
Type o entification.
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'Pr used
i nature No
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No Puti
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°:Not lic -State of FloridNo.
Commis#ion No. oCommission.N
:Notar,yy PU�p is -Slap or Florida
o Cba0on GG 062220
GG 062220
16, 20
Fignature
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My Comm. Expires Mar 18. 202
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y Comm. Expires Mar
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"fir Bonded Wough National Notary Ass
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Rev. 8/2/17