HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �" ��' �� Permit Number: 11106 "023L9
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Building Permit Application MAY 10 G1Jsr
Planning and Development Services
P�Fi:•!iiTTi;:G
Building and Code Regulation Division St. Lucie C cuniy, i-L.
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
1 Q,Y2�Un► rr���q
Property Tax ID#:�0 8 1(6- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
i+Cr)en em o d-Le,t
�U�P c�� � �Y-1 rL% C:_,W1 -t nJ_P U*moo load
CONSTRUCTION INFORMATION:
Additional workto e e orme under this permit—c ec a apply:
❑HVAC Gas Tank Gas Piping Shutters a Windows/Doors
1-1 Electric Plumbing Sprinklers Generator Q Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ �1� Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
NameG'' \ Name:
Address:L�(8 Company: CalAO nrh.
City: • C_A '- Stater 1 , Address: .� A .)
Zip Code:,;7q /( Fax: City:(Acu + State=L
Phone No. p� •^'• �c J Zip Code: Fax: r--
Phone No.()v 1
Fill in fee simple Title Holder on next page if different E-Mail: 1
from the Owner listed above) State or ounty 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 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 Commencement.
• s
Signature of U n r/Lessee/Contractor as Agent for Owner Signature t LicefisbH
STATE OF FLORIDA I STATE OF FL
COUNTY OF ��r-Q-Q� COUNTY OF .
The forgoing insti;urriqpt was acknowledged before me The forgoing ins rument was acknowledged before me
this day of y 201 by thi day of 20 �by
(Name f person acknowledge ) (Name of erso acknowledgin
( gnature of Notary Public-State of Florida) Sig ature of Notary Public-State of Florida)
Personally Known OR Produced Id ntification Personally Known d e if a ' n
Type of Identification Produced . Type of Identifica ' n QP,, c d
'•��` Notary Pub' ate o1 Florida
Commission No. (Seal) Commission No. '•- xref
y Comm.Expires Jun 21,2018
OF Commission#FF 106794
Notary Public-State o1 Florida
Revise My Comm.Expires Jun 21.2018
-��•' ��:' ion#r FF 106794
REVIEW O T ZONING SUPERVISOR PLANS., VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW` REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS