HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE CCOMPLETED Fun APPLICATION TO BE ACCEPTED `
Date: b Permit Number: I 0 �(o 06 0� I
SCANNED
�u BY
St. Lucie County
-- --- Building Permit ApplicationcF,l�O
Planning and Development Services JUN 2 9 Jnjg
Building and Code Regulation Division Perrniltin
2300 Virginia Avenue, Fort Pierce FL 34982 / St. Lad Coalmen
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial b Residential
PERMIT APPLICATION FOR:
Address:
Legal Description:
PropertyTaxlD#: .���� pis'(70-16S-Oc0'a Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No.
Haamonai worK to oe perrormeo unaer tnis permit— cnecK aii tnat apply:
_Mechanical Gas Tank _Gas Piping _Shutters —Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator LRoof I Pitch
Total Sq. Ft of Construction: ..?d D O Sq. Ft. of First Floor: 3. D D'(J
Cost of Construction:$ /ZfG6 Utilities: _Sewer _Septic Building Height: /6
OWNER/LESSEE:
CONTRACTOR:
Name:. 2 �i �//
Na1. me:. '1 "
Address:. S 91 d % udl/✓ 1'1 ke i
Company: - '' YL L
City: T State:.6
Zip Code:'r Fax:
Phone'No:, 772-- L-03-, 7-%
Address:
City-:
ZipC e:' !,,3Vf Fax:.
Phone No ri 72- D ,
State:_
d d—
E-Mail: i '''
Fill iri fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail - A,, n e
State or County License C C L f
3a-6 7y�
If value of.consttuction is 2500 or more, a RECORDED Notice of Commencemenvis required.
SUPPLEMENTAL CONSTRUCTION 2W LAW NJ
DESIGNER/ENGINEER: _ Not Applicable
Name:
MATION:
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
commencing workorwQording vour Notice of Commencement. _,C
Signature of Own / Lessee/Contractor as Agent
for Owner
f Contractor/License Holder
Signat10F
STATE OF FL RIDA
STAT FLORIDA
COUNTY O S� ���
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this Z 20�by
I- day of JUyi r
this day of �i1v� r . 20Lk-by
/�
�'! �an 4f 40r'5
,d/IV 1/ /O&*6
(Name of person
,CJperson knowleddgging)
X�Grs. ,/"
(Name of person ackno ledging )
(Signature of Notary Public- a e of Florida)
(Signatuf a of Notary Public- S e of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification T�
Produced
os="o.,
Type of Identification
Produced
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Commission No. (Seal)
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Commission No. (Seal)
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