HomeMy WebLinkAboutSUBMITTED PAPERSAll APPLICABLE INFO MUST BE COMPLET' :OR APPLICATIOhrTO BE ACCEPTED
Date: L SCANNED Permit Number:
BY
St. Lucie County
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
PERMIT APPLICATION FOR:
Address:
Legal Description:
Residential
Property Tax ID #:
L?492 —/�—®�a
S-Q���jr
Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back:
Right Side: Left Side:
z-s-
eer
u..w n.I wV!. w uc Pcuuu ucu uuuai uin Pnnm—WnaLrt an uidL dIJPry:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing —Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 3 / � 5
Cityh': rr,p •, a ^x=
State:
Zip Code: Fax:
Phone No. 77a yi la 9� _
E-Mail:
Sq. Ft. of First Floor:
Windows/Doors
Roof
Utilities: _ Sewer _Septic . Building Height:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
City: LOFT ST UCIe. 0 �J State: R.
Zip Code: 349,%2 Fax: 77.1 33S- 1149
Phone No. 772 33,5 -30 3 2
E-Mail:_ CUAC'it' sus V ao)-ao,,,
State or County License: CflC05IRlO S4CLt&'
If value of construction Is258Tor more, a RECORDED Notice of Commencement
r
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name: _
Address:
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 priorto 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
commencingwork or recordin our Notice of Commencement.
Signature of Owner/Agent/ Lessee
Signature of Contractor/L tense Holder
STATE OF FLORIDAJ� �
STATE OF FLORIDA
COUNTY OF /C('�Le
.
COUNTY OF
The forgoinginstru nt was acknowledged before me
this dray of / Pi 20 /1%by
The forgoing instru ent was acknowledged before me
this day
_-Z of i 20Zk'by
L/CA.T/.S ail?�J✓S
�tr�Tl� a �i/i?on S
(Name of person acknowledging)
(Name of person acknowledging)
L�L/2 Q�
(Signature of Notary Public- St of Florida)
�OR
(Signature of Notary Public- State orida )
�OR
Personally Known Produced Identification
Personally Known Produced Identification
Type of Identification Produced aj r v„ �P.,,,,,IEB.EMBLI
HType of Identification Produced
e ;
Commission No. p P p MYCOMMISSICNfEE852S4
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