HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
qcb-ob5 71 GENE®
Building Permit Application JUL 3 12017
Planning and Development Services
PERMITTING
Building and Code Regulation Division
St. Lucie 9,dunty, 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
PROPOSED "IMPROVEMENT LOCATION
Address: I—VI=\S Nc'\
Legal Description:
Property Tax ID #:
Site Plan Name: `
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION:-OF.WORK:
CONSTRUCTION INFORMATION: °
Additional work to be performed under this permit— check all thatapply:
F1HVAC E Gas Tank Gas Piping _ Shutters a Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: le S . Ft. of First Floor:
Cost of Construction: OM 00 Utilities:Sewer'❑Septic Building Height:
OWNER/LESSEE _..
CONTRACTOR
Name
Name: `X ,Zh
14_
Address: eS
Company:
City: 7 Qs � X\ StatW
Address: LA
Zip Code: _Jy�`1� Fax:
City
State 'V L
Phone No.
Zip Code:3�4g�& Fax:
E-Mail:
Phone No. �oQ) — C)
a 'K�,0
Fill in fee simple Title Holder on next page (if different
E-Mail: =h a moi-i 2 2-619
6t-4+vi1c+
State or County License: 9_01 T_
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from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
n
SUPPLEMENTAL CO,NSTRUCTIO;N LIE1V LAW INFORMATION' ,. _. ._ _. .
DESIGNER/E GINEER:
Name:.
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: Or
State:
City: State:
Zip: Phone:
a3
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 woxk or recording vour Notice of Commencement.
r (v c I -
as Agent for Own9K Signatur of Contractor,
STATE OF FLORI
COUNTY OF
The forgoing instrument was acknowledged before me
this\y day of `> 20\7)Lby
STATE OF FLO��
COUNTY OF
The forgoing instrument was acknowledged before me
this � day of ., _ 20 1a by
(Name of perso nowledging) (Name of person acknowledging)
(Signature of Notary Public- State of Florida) (Signature of Notary Public- State of Florida )
Personally Known ✓(i�rlehtifieataeri Personally Known —r.)Id ced Identification
STELLA M. HUNTER
Type of Identification Prod , Type of Identification Pr dkcea „
. oe 1C - a e o Florida k �a'ICLLA
r + • Co iss n # FF 180552 `y`� Notaryy
1 +4�- Cor>}►$�� State Nof Florida
Commission No. s • ` el Commission No. , ss n # FF 180552
My Co m, ires Jan 23, 2019 a:
'''° ��•�, Bonded through National Notary Assn. FpFF�o;; My Comm. Expires Jan
23, 2019
—Wilvallona otaryAssn.
Revised 07/15/2014
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