HomeMy WebLinkAboutBuilding Permit Application1
ALL APPLICABLEINFO ]MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date_ ) - / (a Permit Number:
DECEIVE®
Building Permit Application AUG 11 2016
Planning and Development Services
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 drQpbox, click arrow at the end of line I
PROPOSED IMPROVEMENT LOCATION-
PropertyTax ID Lot No.��
Site Plan Name:
Project Name: Nam:` SX\g=%
l
Setbacks Front_ Back:
DETAILED DESCRIPTION OF WORK:
Right Side Left Side:
Block No.
�c-
CONSTRUCTION INFORMATION: III
LJHVAC LI Garas Tank Gas Piping Li Shutters Windows/Doors
OElectric L'� I Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
__V
Cost of Construction: $ ��-�. ��- Utilities: L_ISewerSeptic Building Height: _
I --
OWN ER/LESSEE:
CONTRACTOR:
Name S
Name:
pL
Address: -`
Company:
City: State:SL-N&
c
Address:),,�� C�
City: ?�� Q N,\ State: `L.
nn ^
Zip Code:
�Fax:
Phone No. 9� W
Zip Code: '_SygQ,0 Fax:
E-Mail:
Phone �rAh- 2LLn
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License:
1 L
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
S,OP.PLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: e.S
_
Name:
Address: cJJ 'C
Address:
City: ttr kJo-c- State:
City: State:
Zip:'S�s 3Nb 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.
d A"d�' -,h ILO s
_ ignature of Owner/ Lessee/Agent Si ure of Contractor/License Holder
STATE OF FLORIQA. STATE OF FLORIDA
COUNTY OF e COUNTY OF _Z;L
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this \ day of 20\\oby this N day of V'40y' %\.. . 20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- State of Florida) (Signature of Notary Public- State of Florida )
Personally Known 100'--OR Produced Identification
Type of Identifi
Commission NoI =,r.' #,�Notary Public jS`F'R Sta of Florida
_ mmissioA �180552
'v�• * 'oc My Comm. Expires Jan 23, 2019
Revised 07/
Personally Known ` .-- OR Produced Identification
Type of Identificatio; hhMUW
�
Commission No. ;= o.
STELLA MHUNTER
Notary Pu(§94ate of Florida
'-' a : •
f
Commission # FF 180552
::♦ a v�
o:
My Comm
t ;. ,• P
Bonded through National Notary Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS