HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAIIAPPLICAUEIIf0 LIST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
/
St. Lucie
County I
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34992 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID #: ��L`Z • �( • �� (`� C�CO •01 Lot No.��
2
Site Plan Name: �'� �` Block No.
Project Name: �tcr-
Setbacks Front Back: Right Side: Left Side:
10
wore to ne pe
nical
r tnis'permit -
_ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing. j - _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ l oZs:�
_ Generator
Sq. Ft. of First Floor:
_ Windows/Doors
Roof
Utilities: —Sewer _Septic Building Height:
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OWNER/LE ,SE—"Ew, <
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Name
Name:
Address: W
Company:
City: ` State: L
Address: -1
Zip Code: Fax:
City: �� L State:��
tt
Phone No.���' 1l(J''l
Zip Coder r'-2(-o Fax:
E-Mail:
Phone No, 15;nN •3—�2 5
Fill in fee simple Title Holder on next page ( if different
E-Mail:
from the Owner listed above)
State or County License:
It value of construction is 2500 or more, a RECORDED Notice of Commencement is required. `�
SUPP
=MEN rA� Cf►� NS�TRUCT • N i.1�N ' . NPORMATION�
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 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
commencine work or recordine vour Notice of Commencement.
Signature Owner/ Agent/ Lessee
Signature of Co or/License Holder
STATE OF FLO
STATE OF FLO /
_
COUNTY OF. Sz_X''
COUNTY OF [� I P
The forgoing instr en was acknowledged efore me
The forgoing instrument was acknowledged before me
this day of O�by
this day of c✓ 20 ��by
l
(Name of person acknowl dging)
(Name of person ack owledging )
9 15�1
Q���
(Signatur of Notary Public- State of Florida
ignature o otary Public- State of Florida)
.•,
✓OR
Personally Known ✓ OR Produ
e o all Known Produced Identification
9-
Type of Identification Produced .�''��"` Pao -,
T�yyppe o, a ification Produced
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Commission No. �b J'1�i :,";• arc My Comm.
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REVIEW
REVIEW
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DATE
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DATE
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Rev. //LU14