HomeMy WebLinkAboutBUILDING PERMIT APPLICATION, I
All APPLICABLE INFO MUST BE COMi'---.-ED FOR APPLICATION TO BE ACCEPTED
Date: �-a' 1�- Qr�A Permit Number:.
ININIrzu
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 Residential - i
PERMIT APPLICATION FOR:
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Address: SlYO4 Pa o Ao e- � C,'r AP F V. Xe r ce 11 391S/
Legal Description:
Property Tax I D #:
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
o'-.11 "/24'r kec"Ir- 1: v e-
clitionalworKtobepertormea uncier
—Mechanical — GasTank
— Electric t/ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 3,9,0. 0-,()
Lot No.
Block No.
permit - cneCK an tnat appiy:
Gas Piping — Shutters Windows/Doors
— Sprinklers — Generator Roof
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Name 0 41"
Address"
1 D(cnyee State:
Cityt Fl-
Phone No. 7 7 2 2 Q,:�_ _6'/ 04'
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Company.';,,
Add'ress:'� 229�' Y�4
City: 'A!�4 State: PL
Zip Code: 3 9 99 3 Fax:
Phone No. _.'� 7 2 4-J*Wz3 41� (6) 73 4/ 9
E-Mail: 4;�W-
CJ/ 6
State or du'nty Licen(sJe: 2 7 t? I?
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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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 County makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an9covenants 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 Mcording your Notice of Commencement.
Y"
Signature of Owner/
Lessee Signature
,ffonglctor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this a day of 20 t� by this Z— day of 20 by
(Name of person'�cknowledging (Name of per!�odn acknowlQdging)—
(Signature of Notary Pubftt- State of Florida (Signature of Notary Public- Nate of Florida
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Pill ype of Identification Produced
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Commission No. mmission No. LAStfflINGRAM
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lic - tate of Florida
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Notary Pu I or
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UPPOIJ 10 Wis - 3!lqnd AjeloN My Comm. Expires Doc 20, 2018
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REVIEWS FRONT" TOrilN—G SUPERVI307 PLANS VEGE T1 QPR 41�2qqhgior Da E
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
COMPLETED
DATE
Rev. /2014