HomeMy WebLinkAboutBuilding Permit Application FROM :cast electric FAX NO. :7725699775 Apr. 30 2017 6:38PM. P12
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date, Permit Number: A9J - 0009.
Building.Permit Application
Planning and Development Services
Building and Code Regulation DiviWon
,2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(M)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow atthe Ond of line
Address: 6)
f
Legal Description:
Property Tax ID Lit _0��. Lot No.,
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
tA-
41'
bona war Elope
rformed under this permit-c ec il appy:
1JHVAC Gas Tank Das Piping Shutters F Windows/Doors
IRElectric Plumbing E]Sprinklers Generator Roof Roof pi"
Total Sq.R of Construction: S . of First Floor,
Cost of Construction: utilitlesn Sewer F Septic Building Height,
31"'W"I'll W."19 W
Name- Name:
Tiqe-b
Address: Company: C
4 e,
City- State: F1 Address:, - ',? I o,,e� 12
- 2
Zip Code: Y Fax: city: State; r! '
Phone No. VpCode:
Fax:
E-Mail: Phone No.2_2 ?
Fill In fee simple Title Holder on next page If different E-Mail-
from the Owner listed above) State or County License.,
If value of construction Is$2500 or more,a RECORDEo Notice of Commencement is-requited.
7
1 "
s1 k
SUP PLEMENTAL,CONST'RUCTION LlEN.LAW.INFORMATJON
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. f'
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 FLORIDA,,, STATE OF FLORIDA
COUNTY OFC ,. COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thls&L day of Y�, 20 _11by this j='L day of�_'� 20 Q by
(Name rson acknowledging) (Name of person acknowledging)
1
V
i
( nat e o otary Public-State of rida) ( kr.-du of No Public-Sta Florida)
I
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification4,roduced .
Commission No. !! Y`�;,;.- T (Seal) Commission No. r `SU". %�`�,' �A
11 °`'�� No oSNAHNA INGR My GP
G ry public-State AM
a eo
'Nq "o`�`'MY Oomm.Expire$tate o1 Florida '�rPP,;h4,1``�y �ommissions Dec 20,2018
Revised 07/15/2 14'%,,a�„o¢,��'' Dammission# Dec 20,2018 {- 8onded throu8h Natio FF 177298
8onded thr 7 J72gg nat Notar
otarY Assn.
REVIEWS FRONT ZONING SU ER PLANS VEGETATION 'SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
I ,