HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE CCI:,.. -- _ + D FOR APPLICATION To BE ACCEPTE
Date: . /DJSCANNED Permit Nu
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BY
St. Lucie County
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Building Permit Application RECEIVED
Planning and Development Services MAY 10 2016
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
Address:
Legal
PropertyTax ID #: LV LZ)— (
Site Plan Name:
Project Name:
Setbacks Front Back:
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Left Side:
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Lot No.
Block No.
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:CONSTRl1CTION
INFORMATION -
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1JHVAC
ElGas Tank
Gas Piping
_ Shutters
Q Windows/Doors
Electric
Plumbing
Sprinklers
E Generator
1:1 Roof ,
Total Sq. Ft of Construction:
Cost of Construction: $ A-10I
S Ft. of First Floor: _
Utilities:llSewer E]Septic
Building Height:
OVNNER/LESSEE
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CQNTRACTOR
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Name
Name: Cw
Address:y2(oQi> Na�Jr 9 6wc3,
City: Rum C 4%t—I Stater
Company:
Address: Kel
Zip Code: Fax:
City: t
Phone No.
Zip Code:
Phone No.6(Q 1 —IL4 �0
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E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail: AA0
State or County License:
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. Q(w cv u r
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DESIG R/ENGINEEt
Name:
_ Not Applicable
MORTGAGE COMPANY: _
Name:
Not Applicable
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Address:
City:
Zip: Phone:
State.
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not
Name:
Applicable
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 Counttyy 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 your Notice of Commencement.
_ Signature of Owner/ Lessee/Agent
STATE OF FLOR
COUNTY FL b Ste`
The SS�ojng inst meat was acknowledged before me
thi L day of Y� 20 aby
Ge &c d Dace �r
(Name of person acknowledging)
Dud kkot,
(Signature of Notary Public- State of Florida )
Personally Known " POR Produced Identification
Type of Identification Produced
Commission
Revised 07/15/2014
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Signature of Contractor/License Holder
STATE OF FLORI 2C „
COUNTY OF � IJl.U1"t J
The^^forgoing instr en as acknowledged before me
thi9r! 1 day of -MIT - . 20 1�0 by
915'r0, d LOOS-I:r
(Name of person acknowledging)
(IDS c&V--
(Signature of Notary Public -State of Florida )
Personally Known V OR Produced Identification
Ve of Identification Produced
No.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS