HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / f
Date. ? i SCAN --
SCANNED Permit Number: 1� r
BY
Lucia County
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 452-1553 Fax: (772) 462-2578 Commercial :� Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Addres
C111Y1'�:
Property Tax ID #:� " LJr--I- _its U(JU y —Ct�C, Lot No.
Site Plan Name: _ Block No,
Project Name:
Setbacks Front Back: Right Side: Left Side:
( C) ko�o 1 Z7� KoX- Ba11 room
L-t-aHVAC L.,,J Gas Tank UGas Piping
11 Electric Q Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $��
Na
Shutters windows/Doors
Generator '[] Roof
S Ft. of First Floor: _
UtilitiesSewer Septic
"`Y;— — r lit C— State: `tL—
Zip Code
Phone No.5�ff l cam"
E-Mail:
Fill in fee simple Title Holder on next page ( If different
from the Owner listed above)
Building Height:
,wame: Ly
Company: La��� � k3
Addr ssfill
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City o a • U' l
Zip Code: Fax:
Phone No. S -m
E-Mail:('�tPYIiS�7f fiC (ACC►.1160
State or County License•( jAr 1� i
If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required. R,
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DESIGNER ENGINEER +Not Applicable MORTGAGE COMPANY: _ _ Not Applicable
Name: 7 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: Pho e; 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.
5t. 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 an applicable Home Owners Association rules, bylaws 4r and covenants that may reStrio or prohibit such
structure. Please consult w th your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the grating 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 perr iit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swim ning pools, fences, walls, signs, screen rooms and accessory uses to another non-resldential 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 first Inspeclion. if you intend to obtain financing, consult with lender or an attorney before
commenhine work or Olecordinia vour Notice of Commencement \.
0
51gnature of Owner/ Agent) Lessee
STATE OF FLOR DA
COUNTYOIL\1Dl%
The,fo cing instrume two ackn wled a efc
this} day of' 11 '.J _ . 201WJ by
Sign att re_df' ontractor/License Holder
STATE OF FLJ D
COUNTY Ot` • uc.�e
Thefprgoing instrumen was acknowledged before me s;
this day of- ' l C7 20®by
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(Name o person acknowl
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(Name of person acknowledging)
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(Signature of Notary Public-
State of Florida)
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y
(ignature of Notary Public- State of Florida)
n,
Personally Known'
4 OR Produced Identification s+
Personally Known L—,---OR Produced Identification
Type of identification Proc
uced
Type of Identification Produced
Commission No.
Commission NorE j.u�! (Seal)
i
Revised 07/15/2014
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