HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '�'r1' �� Permit Number: nor,... ........
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Building Permit Application
AY 0 5 2017
Planning and Development Services PERC!IIT'iNG
Building and Code Regulation Division St. Lucid ounty, FL
2300 Virginia Avenue,Fort 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 line
PROPOSED I'M'PROuE�M'E�NT LOCATI®'N:
Address: r/
i
Legal Description: Ze
Property Tax ID 10 nlog- 0 acl , qLot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
®ETAFLED DE�SCRI'PTI®N OF 1IVORK:
W.
C®NSTR,UCTI,ON INFOR' ATI®N:
Additional work tobene orme under this permit—check a appy:
HVAC LJ Gas Tank []Gas Piping _Shutters Windows/Doors
Electric ElPlumbing
' sprinklers E Generator F] Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
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Cost of Construction:$ /�/Y� Utilities: _Sewer 0 Septic Building Height: _
®W2N=ER LESSEE: CONTRACTOR:
Name Name:
Address: _ "Company:
City: State: Address:
Zip Code: Fax: City: State:
Phone No. Zip Code: Fax:
E-Mail: Z.9, Phone No.
Fill in a 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 RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LA`W IN:FOR111C,DN:
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 Countyy makes no representation that�is granting:a permit will'authorize the,permit holder to buildAhe subject structure
which.is in con-lict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
sfructure.,Please consult with your Home Owners Association and review your deed:for any restrictions,which may apply.
I consideration onsideration 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 yoAr NoticV of Commencement.
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Signature of wn ess a JContrac r nt forowner ,Signature of Contractor%License Holder
STATE O FLORIDA STATE OF FLORIDA
COON ,OF COUNTY-O,F,
The folgoing instrument was acknowledged,j�efore me The forgoing instrument was acknowledged before me
this�day of rn�Ay 20 'by this_day of 20 _by
(Name oerson acknowledging (Name of person acknowledging)
c9--�
(Signature of Notary Public-State of Florida) (Signature of Notary Public-,State of Florida)
Personally Known OR Produced Identification / Personally Known OR Produced Identification
Type of Identification Produced L Type of Identification Produced
Commission No. n No. (Seal)
KAREN S. NI LSEN `�
`yJ/'
P u
:°` ° Commission tf FF 115637 1R
My Commission txp
Revised 07/15/2014 EOFi° June 12, 2018
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DATE
COMPLETE
INITIALS
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