HomeMy WebLinkAboutBUILDING PERMIT APPLICATION-,�5i25
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: IOc. AA- 1 I Permit Number: / 0 �
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SCANNED I ECEIVEU
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cie Gounty DEC-2 0 2016
Building Permit ►pplication
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 dropbox, click arrow at the end of line
F OP.OSED N ROVEMENT,LOCATON
Address: a/ 7J ti iC�
Legal Description:
Property Tax ID#: N "!hQ —oql — Lot No. C
Site Plan Name: / Block No.
Project Name:
Setbacks Front off- j Back: Right Side: �' _ Left Side:
KTAILED DESCRIPz ORTION OF WK
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CONSTRkTlON INFORMATION:.: a < f,
ttiona wor to e erformed un ert ispermit—check all
❑apply: j�
HVAC Gas Tank ❑Gas Piping ❑ Windows/Doors
_Shutters
❑Electric 0 Plumbing rinklers ❑ Generator ❑ Roof
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Total Sq. Ft of Construction: S'C Ft. of First Floor:.
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Cost of Construction: $ Utilities: Sewer V.J Septic Building Height:
OWNER/LESSEE
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CONTR'(yCTOR
I Name
Name:
Address: /!
Company:
City: State:
Address:/ lo® f%
City: C/ P, faState:
Zip Code: ® Fax:
Phone No. /�W5 0
Zip Code: Fax:
E-Mail:
Phone No.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: 0 r
State or my j.jcens�� �%17
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
-SUPPL ,YJENTA C7NSTR[1C EtgN kjE1V LAiN 1F
1DESIGN ER/ENGINEER: Not Applicable
Name: t 1 ItA
RMATIO g e . ;.
MORTGAGE COM ANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone:
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name: L I
_NotApplicable
BONDING COMPANI: _Not Applicable
Name: / In
Address:
Address: IV It'
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
of Owner/ Lessee/Agent
9 Gleam 5
Signature of Contractor/License Holder
STATE OF FLORIDA� n y�P STATE OF COUNTY OFORIDA� n
COUNTY OF P'/kJ[/lYL, lU
�y
The foLgoing instru t was a knowledged before me The forgoing instru ent wknowledged before me
this day of. 20 by thisr%a ac
day 20 by
1
(Name of person acknowledging)
Personally Known V
Type of Identification
Commission No.
Revised 07/15/2014
:-State of Florida )
OR Produced Identification
iced
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`�`¢• '? M�(<;@�LIISS,& # FF 014070
`•. ;e` EXPIRES: July 27.2017
(Name of person acknowledging)
qm-'� tLq-01-
(Signature of Notary Public- late of Florida )
Personally Known OR Produced Identification
Type of Identification P ........
Commission No.
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