HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2 -ix n Permit Number:
`
41111111111 RECE-WhUl
FEB1 3 2012
Building Permit Application
.
PERMITTING
Planning and Development Services St. Lucie County,FL
Building and Code Regulation Division
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 IMPROVEMENT LOCATION_
Address: qiQ RfQ M 0 �ax- ULLA y0 �f ICA ` o
Legal Description: �) "1 U b I AJC
Property Tax ID#: ;� I=I-1 VD- DDI U- WV'2 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
new
CONSTRUCTION INFORMATION:
Additional work toe ne rmed under this per -check all appy:
HVAC 0 Gas Tank Gas Piping _Shutters Q Windows/Doors
11 Electric El Plumbing Sprinklers I Generator E] Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ �]d���d Utilities:Sewer Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Name:
Addr�pss: ]�� C� JAn06G,r C�f Company: nC .
City: 40&A-. Uy te_ State: Addres V► �.
Zip Code: , a Fax: City. 1.1 State:
Phone No. Zip Code: Qft Fax: � b 11- to(
E-Mail: Phone N - ��C)
Fill in fee simple Title Holder on next page(if different E-Mail: Yl$� ! f S ( 9
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 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 thepermit 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.
A%// s
Signature of Owner/Lessee ontractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID& STATE OF FLORID
COUNTY OF a UUA-e, COUNTY OF 1_)_k_
The f oing instr a was ac n wledge efore me The forgoing instrument was acknowledged before me
this Ty day of 20 by this_to,day of 20 --Z by
JIM
(Name oerson acknowledging) (Name of erson acknowledging)
jx&�b
(Signature of Notary Public-State of FI a) (Signature of NotaryPu ic-State of FI da)
Personally KnownOR Produced Identification Personally Known OR Produced Identification
Type of Identificati Produced Type of Identificationruced
Commission No. ommission No. �
aogPNc Notary Public State of Florida o.0yP(i`F Notary Public State of Florida
: , r ^ At. M Paula p_
8� My Commission FF 191201 c My Commission FF 191201
Revised 07/15/2014 °p�°� Expires 02/27/2019 OF F'o Expires 02!2712019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE ^_ .1
COMPLETE p� 01-V
INITIALS d--p