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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: J��Q� ] SCANNED PermitNumber: BY St. Lucie County 0 - — -_ 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)462-1575 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROVEME.NT--LOCATION Address'/67 f/ �� XIA .tl 01 jo fAz� Legal Description: �c f��AZ6!VA Y1L doNl� ZZ4t ' XleW Property Tax ID i#: /�/1- —©8o - Z Lot No.. Site Plan Narpe: , Block No. Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION -OF WORK:., CONSTRUCTION INFORMATION itiona wor to e e orme un ert is permit- cneck au tatappy: ❑HVAC Gas Tank []Gas Piping Shutters ❑ Windows/Doors Electric El Plumbing OSprinklers Generator Roof Roof pitch Total Sq. Ft of Construction: S Ft. of First Floor:. Cost of Construction:$ ZS f i Utilities:SewerE]Septic Building Height: GINNER%LESSEE.;; .CONTRACTOR Name. Name Address: SI6fl, 61HFtqr f O7- -/Dd f company: City: r02'r Plerza State: FL Zip Code: 3 L 9 q7 Fax: Phone No. Address ei City State:_ Zip Code3 Fax: PhoneNo.�J4/..,3 :�Ze5? E-Mail: Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail: /� State or County. License: <f liZZJE>!�V If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. rSUPPLEMENTALCONSTBUC=TION-LIEN LFI:W INFORMATION _ - DESIGNER/ENGINEER: _ Not Applicable Name: MORTGAGE COMPANY Name: _ Not Applicable Address: Address: City: State: Zip: Phone City: Zip: Phone: State: FEE SIMPLE TITLEHOLDER: _ 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. 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 COmmencina work or recordina vour Notice of Commencement. �_ ^ e Signature of Ow as Agent for - & ature of Contractor/License Holder STATE OF FL�e1r/DLess�ee/Contractor ,owner OFO��- -,4— COUNTY OFO COUNTYOFSTATE The o 1n instru nt was acknowledge before me The forgoing instrument was acknowledge before me this day of 20 by this day of `� ru /' 20by Name of perso aking statement Name of perspAiWaking statement Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification j Type of Identification Produced Produced r ign re of Notary Public- State of Florida ) (Signatu of Nota Public- Sta of Florida) COm SslOn NO. �' `�''J�w. J(blic-S,RRETi "Sypue, ANGEL�7pYOUNG COmml$$10❑ No. YCOMMIS51 w)1961069 ..{'..,4s Notary Public -State of Florida Commission # GG 243242 * ' " �„ a EXPIRES:April 12. 20?9 -- - `Prm. My Comm. Expires Sep 28, 2022 ��Fgpf BBneeefimBuG�etNotery Sernces owcec throughano at Notary Assn. REVIEWS FRONT MMOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17