HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETEp F([�+p(PPLICIT,IQN TO BE ACCEPTED
Date: CJ' �7, Permit Number:
�7n RECEIVED
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Permit Application FEB / 8 2017
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Planning and Developrneht5eryices`
Building and Code RegylatipnDivisigh';' .
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772),462-1553- Fax:(772)462-1578 Commercial Residential
PERM ITAPPLICATION FOR: To Select from dropbox, click arrow at the end of line
PFtO,POSED IMPROVEMENT LOCATIO.I� h ••���dG���., .:'z �j_a,ri.,s � �,��Sy�� ,t.�� },�� .s. �., .•. ; `��
Address:
Legal Description:
Property Tax ID#: �t�l ® Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional workatoe ertormed under this permit—check all appy:
HVAC G Tank []Gas Piping Shutters Q Windows/Doors
aElectric LSI Plumbing Sprinklers ElGenerator El Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ o o Utilities:Sewer Septic Building Height:
O�IVNER/LESSEE ' CONTRACTOR
N,R
Name 0 Name:
Addr ss i Company:
City: State: Address:
Zip Code: Fax: City:T�L.vu State
Phone No. Zip Code: 19 Fax: ;--
E-Mail: Phone No.
Fill in fee simple Title Halder on next page(if different E-Mail: )
from the Owner listed above) State or County License:�,F/'
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLSEMENTAL CONSTRUCTION LIEN LAW INFORMATIONz t
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DES IGNERANGINEER:1 _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 our Notice of Commencement.
s
Signature Owner/Lessee/Contract as Agent for wner Signatuie-f Contractor/Licens of er
STATE OF FLORID 1 STATE OF FLORID
2
COUNTYOF COUNTYOF
The fo ng instr a was acknowledged_before me The IfFing instru en was acknowledged before me
this day of 20Iby thisday of 20 jI by
o
(Na e o rson acknowledging) 4meerson acknowledging)
ayt ('(�
(Signature otary P 'c-State of Florid nature of Notary Pub c- ate of Florida)
Per nally Known OR Produced Identification Personal) n Produced Identification
Ty a of Identif on Pr Identification Produ
DBERTY:KING
Commission No. =+: ::: MY C IO77248 Commission No.Bondd Th 017 1
RE envritere 'fir;f�°Q` Boned Thru Notary Public Undenvdters
4f Notary
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS