HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
. NTY . °' l
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 452-1578 Commercial Residential ./
PERMIT APPLICATION FOR: To Select from dropbox, clickarrow at the end of line
PROPC 4Q=fM08.11 i4 �T T1O
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Address:..�p Q . C 1 0t , n —sC�r �+��: a�- 1 Luh i eti F—�
Legal Description:
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Property Tax ID #: ��r�� 7oco` ,41L Lot No.
Site Plan Name: Block No. �-
Project Name:
Setbacks Front Back: Right Side: _ Left Side:
QEi'A#LED QESCR1PTiC1N OF I14ltJK
4 e v- 9A L ElenC� lel C_
$ T cTa I Rt I I.ATJON
Ittona work to be neFffirmed under t ispermit — c1e,1 all apply:
Ii
❑HVAC Gas Tank E:] Gas Piping_ Shutters Windows Doors
_ Electric Plumbing ❑Sprinklers ❑ Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Sq.
of First Floor: _
Utilities: L _I Sewer E-5eptic
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
3R;
Building Height:
Name: 1
Company: 15
Address: P ��
City: 'j State:�-
Zip Code: �f S _ Fax:
Phone No — f E -Mail'
State or County License:(2r&
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone: _
— Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
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, wails, 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.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Lu I COUNTY OF
The forgoing instr ent was acknowledged before me The forgoing instrument was acknowledged before me
this k l day of QV'Cr V'1 20 Eby this _) day of C U a kf' " 20 ('-) by
e"
(Name of person acknowledging } (Name of person acknowledging)
t- 9 A 1/3 fia- '� �' �
=&A-4 L�y VIZ
(Signa re of Notary Public- State of Florida } (Signa ure of Notary Public- State of Florida )
Personally KnownPersonally Known � OR Produced Identification
Type of Identificatio #}` ed Type of Identification Produced
`,:MY
.:
Commission No. EXPIREB>�er20,2p2o Commission N ,;r'."'• ELLE TiA
My COMMISSION # GG055253
Revised 07/15/2014
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