HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: --2 G - / r—/ Permit Number:
SCANNED
BY
St. Lucie
Building�eri it Application
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 4624578 Commercial Residential
PERMIT APPLICATION FOR:
Address: -3O,4 L.
Legal. Description:
Property Tax ID #: 09 G / — ID Lot No.
Site Plan Name:
Block No.
Project Name:�'i`s�n S /
Setbacks Front Back: Right Side: Left Side:
,�' & f4 ..
pertormea un
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ �� �p v
— cnecK a
Gas Piping
_ Sprinklers
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Pi ��: m� •an. � e
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w°
.••
Generator
Shutters
Sq. Ft. of First Floor:
'Windows/Door's
Roof
Utilities: - Sewer _Septic Building Height:
NameyisF® 10' •We.r
Address: :? �, �., x, J,.
City: / -F State: ,/= l
Zip Code: 3 YES a Fax:
Phone No. k-> G G 3L
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:
Company:
Address: p o i3 m 9 a 3
City: State: /=1
Zip Code: -3 Y 9 s s— Fax: 9 9 0 7
Phone No. / �S - 9 9/9-
E-Mail: �{ Os9i •'V► •at./ r G✓v v C`rJ' ,J ` 17l!/• T
State or County License: FC / .3 a o .z 7 3
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.
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 any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
with
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 our Notice of Commencement.
Signature of Owner/ Agent/ Lessee
Signature of Contractor/License Holder
STATE OF FLOR D
STATE OF FLORID -
COUNTY OF
COUNTY OF
The for oing instru t was acknowledged be €�
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The forgoing instrument was acknowledge
this�a of 201 �6 b
this day o 20
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(Name of person acknowledging)
(Name of person acknowledging) z
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(Signature ffNotary Public- State of r1orida
(Signature of lUtary Public- State of Flo ida)
Personally Known O Identifi
Personally Known O duced Id nt c� ion
koduced
Type of Identifi ation Produce�GV" , �`
T�y�'e,�of identification Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014