HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t�(
Date: ' ' Permit Number: I O
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Building Permit Application MAR 2 2 2017
Planning and Development Services PER.MITUNG
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 lL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �� ftt
PROPOSED IMPROVEMENT LOCATION:
Address: as 0 C -�"" A l+ 1
Legal Description: a 4&> Aj i
Property Tax ID#: ��q a 2 - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION;
Additional work to e performed under this permit-c eck all apply:
0HVAC Gas Tank ❑Gas Piping _Shutters ❑.Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ d Utilities ll Sewer 0—Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Name:
Address: b2 6-, Company: _ p,a2
City: 15�)- (�i"Crce. State:rG Address: )g/6 6ul
Zip Code:y���C�j Fax: City: �c�f Lu Gi e., Stater
Phone No. Zip Coder C �_ Fax:
E-Mail: Phone No. a, - 9 776
Fill in fee simple Title Holder on next page(if different E-Mail: / ( ,-aF►rq q L.GG
from the Owner fasted above) State or County License: ,Co/. _ C)
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 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 recordin . our Notice of Commencement.
's
Signature of Owner/ s /Co acto as Agent for Owner _ Signature—o_fConrractc,&ie6nse H
STATE OF FLORIDA STATE OF FLORIDA,
COUNTY OF COUNTY OF' �� L
The f r oing inst as cknowledge before me- The fo oing instrument w's acknowledged before me -
this May of 20-- this day ofMAOC 120 Ja by
(Name of person ackno901-
Pging) (Name of person acknowI d g)
(Signature of Public-State of Florida) (Signature of No lic- tate of Florida)
_ Personally Known R Produced Ident(twof) p Personally Known OR Produced Identification
Type of Identification oduced , is! Type of,Identification' roduced 41R4101111
Commission No. 11�(Se �S 110 Flo-%. Commission No. A S 1 M�SSIONF , y
orb 9`�"•;x 12.CM
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DATE
COMPLETES!
INITIALS