HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
SCANNED
BY
im
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal Description:
Property Tax ID #: I�j01 p� -j� -� C� Lot No. (d
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:
Right Side: Left Side:
& - b'K & U:Xa� �Y_Drn bc� L�� C'Skl-
�rad\ q-lq�j
jaitionai worK to be errormea unaer tnis permit- cnecK an apply:
❑HVAC E] Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
Electric ❑ Plumbing ❑Sprinklers ❑ Generator ❑ Roof
Total Sq. Ft of Construction: 1
Cost of Construction: $
Sq.
of First Floor: _
Utilities:11 Sewer ❑ Septic
Building Height:
OUVNER%LESSEE
s
rexCONTRACTOR
Name S
Name:
Address:
Company:
City: Stater
Address: 0 1.0t
Zip Code:-1�ep Fax:
City:
�1
State:
Phone No`l% . t .- 41oe5- R25
Zip Code: z
Fax:
W
E-Mail:
�1
Phone No. [1.— 4U(
E-Mail:
- 5329
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License:
3bb
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPL M Lo AL�CONST.RUC�710N LIEN L,�V1%INFORMATION a r �
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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:
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.
Sign to o Owner/ Agent/ Lessee
STATE FLORIDA �rC�
COUNTY OF �
The forgoing instr men,'t was acknowledged before me
this day of S1_ 20 14 by
(Name of person acknowledging )
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced _
Commission No.
Revised 07/15/201
SENDA MARTINEZ
Notary ublic - State of Florida
My Comm. Expires May 31.201
Sign
rise Holder
STATE OF FLORIDA— L L"CUL
COUNTYOF J'{
The forgoing instr ent was pcknowledged before me
this Z" (Nlay of 20__14 by
36mo� Mrr�u�r',_
(Name of person acknow edging )
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
mission No.l , �e,4Seal) BRENDA MARTINEZ
?: :° s Notary Public - State of F
Comm. Expires May 31
Commission # EE 986
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