HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number: j5aq "0O5S
Date: D oca� 6GANN�
BY
5 st Lucie County R E�� ��' ED
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Building Permit Application
SEP 2015
0 9
Planning and Development Services
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue, Fort Pierce FL 34982 St, Lucie County, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial V/ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address:
Legal Description
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Property Tax ID #: —s — — Lot No.
Site Plan Name: fe voJpi Block No.
Project Name: P�n�
Setbacks Front Back: Right Side: Left Side:
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EIHVAC Gas Tank E]GasPiping _Shutters awindows/Doors
11 Electric 0 Plumbing Sprinklers 1:1 Generator Roof
Total Sq. Ft of Construction: S Ft of of First Floor:
Cost of Construction: $� �(% Utilities: lJ Sewer Septic Building Height:
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Name
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Company:
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Phone No. l{1?i�' l —
E-Mail:
Phone No., —
Fill in fee simple Title Holder on next page (if different
E-Mail:
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: _ City: State:
Zip: Phone: Zip: Phone: 11
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
commencin¢ work or recordine vour Notice of Commencement.
STATE OF FLORI /,,. STATE OF FLORI
COUNTY OF l�4C,12 COUNTYOF (� -
The fo going instru nt was ackngwledged efore me The forgoing instrum nt was ackn wledged before me
thisday ofDDOi[ tC"i. 20.hy thisday of .20__d by
2k- ld). �lUl IIS�'1f L� �( � ClrY1S
(Name of perso knowledging) (Name of person acknowledging )
(Signaturpt Notary Public -State of Florida )
Personally_Knowa___�/ OR Produced Identification_ _
Type of Identification Produced
4MY
(Signatur& otary Public - State of Florida )
Personally Known OR Produced Identification
Type of rdentification-Produced - - - - - -
Commissi%aklo� _ (Seal)
-• y rWife 544 Of Florlt4
My Comm, Explras INp 1{.20,1
RO. Mslion SEE 6"97n
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
REVIEW
ANGROVE
REVIEW
DATE
COMPLETE
INITIALS