HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE
EEpINFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L� a C) + Permit Number:
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Building Permit Application FEB 2 8 2017
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County, 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 Rei\
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Legal Description: `5
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Property Tax ID#: U ��L� � l'- ? Lot No.t�
Site Plan Name: \ Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work toe nertormed under this permit—check a � appy: a 7 g
❑HVAC Gas Tank Gas Piping Shutters Q Windows/Doors
®Electric �Plumbing HSprinklers F]Generator Q Roof Roof pitch
Total Sq. Ft of Construction: L� 1� S . Ft.of First Floor: l t
Cost of Construction:$�5 , ® � Utilities: Sewer Septic Building Height:
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Name hi Name:
Address: ?)(&C,;1' Company:
City:qi�T4 State:EL Address:
Zip Code: "'�b 3k Fax: City: State:
Phone No. 5 663 CZEMMEW Zip Code: Fax:
E-Mail Phone No.
Fill in fee simpk4itle 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.
Uf"P[: Nl l� CC?NS ) tICTIQN�e 1� 1 U W IC+EI 3RMATIO �
WXVDESIGNERjENG NEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: S a e. City: State:
Zip: Phone: = Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: of 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 Noti of Commencement must be recorded and posted on the jobsite
before the first inspection. If y9V i n o obtain financing,consult with lender or an attorney before
co encin work or recordi o ice of Commencement.
r/ 7Agent
S
gnature of Own / esse /Cont r aOwner Signature of Contractor/License Holder
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STATE OF FLORI A STATE OF FLORIDA
COUNTY OF� T� �( '- _ COUNTY OF
The for oing instrum t was acknowledged before me The forgoing instrument was acknowledged before me
this day of 6 ,•20?'1by this^day of 20 _by
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(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Publi -State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification >✓ Personally Known OR Produced Identification
Type of Identification ProducedType of Identification Produced
Commission No. ission No. (Seal)
KAREN S. NIELSEN
Commission u FF 115 37
=, , My Commission Expires
Revised 07/15/2014 r %%°,°' June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
DATE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
COMPLETE
INITIALS