HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ^
Date: 02 Permit Number: �J
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Building Permit Application FEB t 4•• 2017
Planning and Development Services
Building and Code Regulation Division PERMIT [,NG
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie unty, FL
Phone: (772)462-1553 Fax: (772)46271578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PRC}ROSED INI�ROt/E11�ENT LOCAI'IO.N: [Mimi k
Address: s � _�Off{G f G�� Dr
Legal Description:
Property Tax ID#: (00 9^ d(D3 — _?J Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIRTION OF UUOR'K:
C®N�S�TR+UCTI:QN INFOR1Ul�ATt®N: u F
Additional work to be performed under t ispermit—check all appy:
HVAC Gas Tank E]Gas Piping _Shutters Q Windows/Doors
Electric ❑ Plumbing Sprinklers . 1:1 Generator F] Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ �]�(' Utilities: Sewer 11 Septic Building Height:
ODUN'ER LESSEE: CONTRACTOR:
Name o ; Name:
Address: if Company:''
City: 12 M State:L Address:
Zip Code: 31(0112 Fax: City: State:
Phone No. Zip Code: Fax:
E-Mail: (e, .CO Phone No.
Fill in fee simple itle Holder on n t page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMEiUALvQN�S1" JC:TI0N ll' �( LAW lid -QR,(�tIATI®N.. �.
MW
DESIGNER/ENGINEER: _,/, -Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: /'N-of 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 of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID)► STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instr as acknowledged fore me The forgoing instrument was acknowledged before me
this jT day of 20 by this day of 120 by
�I Y"
� i�Y�re�u� l
(Name of person acknowled ' g) (Name of person acknowledging)
(Si nature o Notary ublic-State of Florida ) / (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification d Personally Known OR Produced Identification
Type of Identification Produced IL, •[, Type of Identification Produced
Commission No. kJ ;?;;a:"" KAREN S. NI
is n No. (Seal)
*-
Commission 4# FF 11563
e My Commission Expires
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
=INITIALS