HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMIkEiED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
BY V
St. Lucie County
NM —5-2 M—M
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 Residential
PERMIT APPLICATION FOR:
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Legal Description:
Property Tax ID #: qq )L (a
Site Plan Name:
Project Name:
Setbacks Front Back:
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0,)0 5- — 000
— Right Side: Left Side:
Lot No.
Block No.
a- o-e- jk6 V P_ P v '�L P (sT L-0
J Ve-Nla , P A -Y" �71 -, I �__
—Mechanical — Gas Tank Gas Piping — Shutters
Electric — Plumbing Sprinklers — Generator
I
lewinclows/Doors
Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ AtIJ& oc� 9. 3, Cd Utilities: —Sewer _Septic Building Height:
��QWNER LES��E'_
C0N,TRP&OR-'
Name 7�; It (A I e, e,
Name:
Address: )1919 kk-� c loo ;-A S�, T�( V '1'�
Company:
City: State:
Address: V"Orhzej
City:_
L,
Zip Code: Fax:
Phone No..
Zip Cocle:?�Mc�Li
Phone No
is 3.
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E ail:
Fill in fee simplel7itle,H61cler on next page if different
E-Mail e% e- K_
State or County License
(0 40 �0
from the Owner -listed 'above)
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
f NT�%,�-:CO NSTRUCTIQN LIENIA 11
14� R '110
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
Address:
City: State:
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY:
Name:
—Not 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.LucieCoun makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conlylict with any applicable Home Owners Association rules, bylaws or and covenants that ma ' estrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions Yhich may apply.
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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
on�m�Wk or recording your Notice of Commencem_ent�
si 6 of owner/ Lessee/Agent
S!, �o ontractor/License Holder
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STATE OF FLORIDA
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0;1�.�' �� ,
STATE OF FLORIDA,
U U r-
COUNTY OF k
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this k - day of 50- -r 20 by
this I � day of SO "W 120 1Yby
�Naje of,#rson acknowledging)
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�(Nameof erso acknowledgin
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gnature of Notary FTo-rida
(Si aturk ofl� h ".
/ersonally
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Personally Known OR Produced Identific
Known OR Produced Identification
Type of Identification
Type of Identification
Produced—
Produced —
Commission N (Seal)
Commission NaWbban (Seal)
'40
REVIE !i�
3rZONING
SUPERVISOR
PLA
VEGETATION
SEA TURTLE
MANGROVE
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REVIEW
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Lisa Greer Bher
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RECEIV?ffv",
My Commi3sion F
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11
DATE
01 Ile,
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COMPLETED
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