HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETEDTOR APPLICATION TO BE ACCEPTED /
Date: l—(� "/S' SCANNED Permit Number:
BY
r 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.
Address: G U .�Ue
Legal Description:
Property Tax ID #: Z y0 5—' .701 — 00 X o D o —G Lot No. Z %
Site Plan Name: Block No.
Project Name: yi
Setbacks Front Back: Right Side: Left Side:
/ U — `l �✓ /? GAG ��/
Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
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If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: - Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
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 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
commencing work or recording your Notice of Commencement.
of Owner
of Co—n1:ractor/License Holder
STATE OF FLOR {� I STATE OF FLORID,#
COUNTY OF Cy=-��C��COUNTY OF
The for oing inst=as acknowledged bef re me
this day of 20
person acknowl
(Signature of Notary Public- a of Florida )
Personally Known OR Produced Identification
Type of Identification °; A DAWN MILONE�
Produced
w y Public - State of Florida
• ; rj tviy Comm. Expires Mar 22, 2017
Commission No. d a °' : CoW1140ion # EE 877571
O° �'•�,, Bonded Through National Notary Assn.
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
COMPLETED
The for oing instru ent wa acknowledged before me
this day of 20_ -'
Personally Known QR rouced &tiflc_ation �• ��
Type of Identification DAWN MILDNE
Produced ` IPaY rl'!'
•� � � ',Iotary Public -State of Florida
• $ Comm. Expires Mar 22. 201,
Commission No. `fl % ; qi8vWPPion # EE 877571
�'� Bonded Through National Notary Assn
SUPERVISOR I PLANS VEGETATION I SEATURTLE MANGROVE
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