HomeMy WebLinkAboutBuilding Permit Application FROM :cast electric FAX NO. :7725699775 Apr. 30 2017 6:34PM P6
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
8ullding and Code Regulation Division
2300 Virginia Avenue,Fart Pierce FL 34982
Phone;(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end' of fin.e
Address:
Legal Description:
Property Tax ID#:
Lot No.-/
Site Plan Name: Block No.
Project Name:
Setbacks Front_ Back-, Right Side: Left Side:
91
Revic'.."C'e kkTA ock me ,LS !
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Additional wor be rformed u ler this permit di—eckall apply:
HVAC MGasTankDGas Piping Shutters Windows/Doors
Electric Q Plumbing []Sprinklers Generator Roof Roof pitch
Total Sq.Ft of Construction: S Ft of First Floor.,
Cog of Construction:$ SZ6 Utilitlesll Sewer Septic Building Sleight:
014
Name IVA, --qV&KqJ Name: 7P J5 t,
Address: A'J-14) � .7-4.IlCv h6ri LA- Company,
(2,44+ —e,Lc&A,�
City: State: Address- C,C',r e J
Zip code:-'?yl. 1441 Fax: city:—Veng -&y-k State: Fl
Phone No., 15&-q- 2 1-0—'q Z? Zip Code: Fax: M
I!r'
E-Mail- Phone No. q-)-
Fill In fee simple Title Holder on next page l If different
I
from the owner listed above) State or County License: Ck 1=g11
if
=ge11if value of construction is$2500 or more,a RECORDED Notice of Commencement Is required.-
SUPPLEMENTAL.CONSTRUCTION LIEN LAW INFORMATION
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:
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%,,11 __ STATE OF FLORIDA
COUNTY OF pc.b.a�� COUNTYOF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 by this day of ��
U �20 Ill by
1v'10 A
(Name rson acknowledging) (Name of person acknowledging)
( natu e o 6tary Public-State of Flbrida) Ofure of Notary Public-Sta Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification;Produced
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Commission No. i (Seal) Commission No. r'�.�r4o,., o LA5 t
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