HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: D/-D+- /4 SCANNED Permit Number:
Ely RECEI
T.- St. Lucie County JAN 0 8 7019
Building Permit Application �, wlie
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: To Select from dropbox, click arrow at the end of line III
ORO-POSED IMPROVEMENT. LOCATION. �-"-_
Address: LPN,
Legal Description:
Property Tax ID#: % �✓�— r/�
Site Plan Name: /J
Project Name: !�,:AAA- z z>
Setbacks Front Back:
- nnn,
Right Side- Left
(';DETAILED bE" " IPTION-OF WORK
Lot No.
Block No.
CONSTRUCTION:I.NFORMATION:-
rtiona wor to e e orme un
ert ispermit—c
ec a
apply:
0HVAC
GasfaA
❑Gas
Piping
tn
_Shutters
❑Windows/Doors
Electric D Plumbing
❑Sprinklers
11 Generator
Roof Roof pitch
Total Sq. Ft of Construction:
SIC Ft. of First Floor:
Cost of Construction: $ o�, ��70.
00 Utilities:
Sewer 0Septic
Building Height:
v
QWNER/LESSEE:' ' =CONTRACTOR.
_'-
F -"•. .-
Name
Name:
Address: L
Company:
X
City: &La State: i2GL,
Zip Code: // r1 �� Fax: o
Phone No, bal — sa 17- Q 9&0r7
Address:
City:��0�> �LO> �1,
Zip Code:
Phone No. �/�%� lO�
States
Fax:
✓�✓�.�
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail: t e Qd LDILdtA�Qli�
&A l &4L -)
State,or County License:
o0-6 9W
If value of construction Is $2500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCT,
.LIEN IAW IN,F.ORMATION 3
T, r , ,' .:
DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAG COMPANY:
Name:
_ Not Applicable
Address:
Address- 02dr,' .PQ
City:
Zip: Phone:.slo/-8��l-QPD
D
State:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: ✓ Not Applicable
Name:
Address:
City:
BONDING COMPANY:
Name:
_✓Not Applicable
Address:
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 work or recording our Notice of Commencement.
D
Signa re of Owner/ Le ee/Contractor as Agent for Owner
Signa re ontractor/License Holder
STATE OF FLORIDA
ST TE OF FLORIDA p/ '
COUNTY OF d�/�C��1J J
COUNTY OF + Xa Z L-
The for oing instru t was acknowledged before me
The forgoing instru nt was acknowledged before me
this day of 20d by
this day of 20-11 by
•• //
Name of personjnaking statement
Name of pers making statement
Known Personally ✓ OR Produced Identification
Personally Known . ✓ OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Sign FloridaMA
COfn s1p q� N#COMMISSIONYGoifis 3q�m COMMISSION#Goifis 3
_,— =E.4• M iwwYar 5 2021(Se )
Co
Seal)
RLAI
p.MY COMMISSION # GG 165M
m® UideiwXen
+8f EVIRES:Oecembor5,2021
••'FeF[��.1.' BWded Thrd Notary Pubic UddB**n
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17