HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONY_
All APPLICABLE INFO MUST BE COMPLES TOR APPLICATION TO BE ACCEPTED
Date: Il I 'I vi SCANNED Permit Number: (`11 I daQ 1
BY
St. Lucie County
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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:�N
CAL
MEMO
Address: y'SA
Legal Description:
Property Tax ID #: 3`� �� ' S d - d a3� 000 - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
i MINIMUM
WKNUM
OLA C- d ti C gjol�� UAlt 3T 5 Kw
Additional work to be perrormed unclert is permit -check all that apply:
,xmechanical _Gas Tank,_Gas Piping _Shutters _Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:. Sq. Ft. of First Floor:
Cost of Construction: $ 3Z �m` Utilities: —Sewer _Septic Building Height:
Name 1
Name: IIF✓, o ,
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Address: I��o S 4rwYvll \}�� twc(
Company: -- i A000- A ti CAr� n c
City: poa S-r ( State: f(-
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Address'Po
City: F�oR`T S'f („Cie State: 'Fc-
Zip Code: Fax:
Phone No. - �(`«o- S 3Ztcl
Zip Code: �5`R 5 Fax:`-
E-Mail:
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
State or County License aC[A (6 (5G'5
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
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 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.
Inconsideration 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 JDr recording Vour Notice of Commencement.
1� A
Signature of Owne tractor
Signature of Contr
STATE OF FLORIDA
STATE OF FLORIIpp
COUNTY OF . 1_J c Y
COUNTY OF Jc t,
The forgoing instru ent as acknowledged before me
The forgoing instrument was acknowledged before me
this3.� da20A by
this jj�_ day of tJo, 26A by
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(Name of person acknowledging)
(Name of perso cknowledging )
(Signature of Notary Publi tate of Florida)
(Signature of Notary Pu c-State of Florida )
Personally Known OR Produced Id e on
Personally Known D�,1�piill,
Type of Identification Np tF1v
Produced State
clde I ,yPub ee,2M1S ,
j
Produced
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858161
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Commission 2• •., �� m,ssin VmE'm�e8�t
Commission No. G�r Gom ��gaM` Aviary
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Seplbtou9
REVIEWS
F
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
CO INTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014