HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: SCANNED Permit Number:
BY RECEIVE®
St. Lucie County
Building Permit Application MAY 22 2o15 Q�
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 (tResidential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
Address: /
Legal Description:
Property Tax ID#: / —J"�/
Site Plan Name: Q/� f nCl�r�wi+y
Project Name: ,4� Avz �(,
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Lot No. r
Block No.
CONSTRUCTION INFORMATION: III
[sIHVAC L 1GasTank LfGasPiping LJShutters
Electric 0 Plumbing [:]Sprint
Total Sq. Ft of Construction: 4_0
Cost of Construction:$ �J`�JrU•l
ars 0 Generator
Sq �Ft. of First Floor: _
Utilities: L-,� Sewer rl] Septic
OWindows/Doors
L ( Roof
Building Height: /
OWNS /LESSEE:
CQNT OR:
Name
Name:
Address: o
Compan :'
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City: '; w cocci 0 State• _
Zip Code.a2! 9, Fax:
Phone No. 77,2 —fib /"7 q07✓�
Address: ! I
City: _ GPi, h c
ZipCode!5,Y
Phone No, e eZI—
E-Mail: r- 5
Stater
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E-Mail: .r
FIII in fee simple Title Holder on next page (If different
from the Owner listed above)
State or County License: !q
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If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required.
4: . ,
SUPPLEMENTAL CONSTRUCTIONLIEN' LAVINFORMAT.ION:
vcarat��ry CIVOIrvCCr - _ IVOL Hp ncaole MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: -7 Address:
City: i°�6 State City: State:
Zip: Phone: /'� 7/�� Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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 andcovenantsthat 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
_ Signatu�. of Owner/ Lessee/Agent I J Signature of 7
ntractor/License Holder
STATE OF FLORIDAc— 0 STATE OF FLORIDA L
COUNTY OF_ • o , COUNTY OF s • cA
The Wing instrument was acknowledged efore me
this 'day of 20I�by
?Il11fe5i11 tion
ypeofl n= nlNNalm2edieStarewFlorida
Traoie L Lam
Comm1551 M Commission EE 159J 4
,y Ixa0712512016 (�eap
Revised 07/15/2014
The fogoing instrument was acknowledged ppefore me
this day of 20 �J by
Q/✓1n6�i t�d/it��
(Name of 6
rson acknowledging) _ I
(Siggidaature of Nota Public- State of Florida )
OR Produced Identification
40 °e,tr� Notary Public State of Florida
Commission ?WOO Trade L Lamb (Sea[)
orxo .
y omm!salon EE 15911
Ezpims011252016
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