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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi-. %LL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: ©���_1 SCANNED Permit Number: gn BY RECEIVED St. Lucie County MAR 06101i1 Building Permit Application Permitting oeportm©nt Planning and Development Services St. Lucie County Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34992 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Address: 51(o Legal Description: Property Tax ID B: 1411 7En —oc?ER--cm— 2 Lot No. Site Plan Name: q9 Block No. Project Name: Setbacks Front Back: Right Side: Left Side: GONSTRtaJCT10N INFORMATION r s , A itiona wor to e e orme un ert ispermit—c ec a thatappy: [IHVAC Gas Tank ❑Gas Piping ❑Shutters ❑ Windows/Doors Electric 0 Plumbing QSprinklers El Generator 1:1 Roof Roof pitch Total Sq. Ft of Construction: S Ft. of First Floor: Cost of Construction:$ Z��L✓� Utilities:�SewerE]Septic Building Height: QWNER/tE55EE F1 - a* _ _. t _ _ _ f _ . CONTRACTOR Name_ .S14m Name: Address: d Company: f k--O— I IF City: 00 rowdState Zip Code: 371YFax: Phone No. Address: J3 q4Q( `7 9 Gr City PiaCa 1 WaG64 State:_ Zip Coder 3154 Fax: rf�' Phone No. Z) T E-Mail: Fill in fee simple Title Holder on next page (if different from the Owner listed above) E-Mail: State or County License: If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. `SURPLEiVIENTALCONSTftUCTIQN�IEN LAVN INFQRMA'FIQ_N � �� �' �• ,=� .' DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _ 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. I certify that no work or installation has commenced prior to the issuance of a permit. St. Lucie Counttyy makes no representation that is granting a permit will authorize the permit holdder to build the subject structure which is in conWict 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 fallowing 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 commenciniz work or recording vour Notice of Commencement. 5fgnature of owner/ Lessee/Contractor as Agent for Owner -Elghature of Contractor/License Holder STATE OF FLORIDA STATE OF FLO A COUNTYOF COUNTYOF FI IM E/4e6ll The foring instr ment was acknowledged before me The forgoing instrument was acknowledged before me this of 2oj � by this ? day of � 20ta by � O,e � - J Est-- - 5 Nam of perso aking statement Personally Known =OR Produced Identification Name of person m ing statement Personally Known � OR Produced Identification Type of Identification ;' Type of Identification Produced Produced f " (Sig a ure of Notary Public- State of Florida) (Signatur of Nota ublic- Stat f Florida ) commission No. - i^.i�."y'�,''? -j��a RRErr '. Notary P is - tote at Florida Commission No. o-Ov-".ueec ANGELAvourJQea� , h11SS1(IN R Fk 9510 �� - P E%PIR'cS:Apn112.2020 i My Comm.CommisExpi es Sep 28. 2022 tg 0? bongw" WoM Natal Sernwa REVIEWS FRONT SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE ZONING COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 8/2/17