HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 'f
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Building Permit Application JUL 3 j 2017
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential C�
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of lin
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Address: /
Legal Description:
Property Tax ID#: Lot No. �0
Site Plan Name: Block No.
Project Name:
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Electric 0 Plumbing Sprinkler I Generator D Roof
Total Sq.Ft of Constructio �� / S . Ft.of First Floor:
Cost of Construction:$ 02 7� Utilities:llSewer Septic Building He
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Name `
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Address: / Company:
City: State: Address:B�iSi /till G4 G
Zip Code• Fax: City: State-
Phone No.
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E-Mail: Phone No.-s-&/- 7ci3-(�2,Rq
Fill in fee simple Title Holder on next page(if different E-Mail: j rt ���O ��jr�/r��/S /�C�. �d�1✓
from the Owner listed above) State or County License: g Ia fo
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Nat Applicable MORTGAGE COMPANY Not Applicable
Name: U�e!J
Address:
, � -� Address:
City(,/ State: City: State:
Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMP ANY• _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 Comm encement.
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`Signature of Owner/Lessee/Agent nature of Contractor License Holder
STATE OF FLORIDA STATE OF FLOIA f
COUNTY OF =� �� / ��— — COUNTY OF
The forgoing instr en as acknowledgg efore me The forgoing Instrument was acknowledged before me
this day of 20'�by this C day of �?0 by
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(Name of person acknowledging) (Name of p rson IcInol
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(Signature of Nota ublic-State Florida) ( ignatu:e of N tary Publ State of Florida a a 0
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Personally Known OR Produced Identification Pers ally Kno n_0�— OR Produced Identifi _n
Type of Identification Pro c Type of Identifi tion Produced
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Commission No. pra�}Llonza Commission No. (Seal} o;VI _
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MY Commission GG OQ4-10 3 axs
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Revised 07115/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS