HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
o ,
ALL APPLICABLE I O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l '1 SCANNED Permit Number: I LOBY
St. Luce Countv 'ECEWE®
Building Permit Application SEP 2 7 2016
Planning and Development Services PER[WITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial X Residential
PERMIT APPLICATION FOR: arrow at the end of line III To Select from dropbox, click a
�.._..I j• :. _ . I : t rn _ -
Property Tax ID #: I \-i n—k 9, Vl i
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION, OF WORK:
dow rg > rG� lid eerie S, tit Crcmcr.
CONSTRUCTION INFORMATION:
Additional to e� e orme under tispermit—checka appy:
E1HVAC 0GasTank ❑Gas Piping _Shutters ❑Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SgI�Ft.I of First Floor:
Cost of Construction: $ � Utilities. LJSewer Septic Building Height:
•
• ' • •T'�r
`N
• • • ' a�1i 1 �,
1►11 - i
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTIONLIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone:
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not 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 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 vour Notice of Commencement.
—Signature of Owner/ Lest
SignaMre of Contractor/Licknde Holder ( I
STATE OF FLORID
STATE OF FLORID
..,
COUNTY OF ` W4 e_-
COUNTY OF `� l�
The IfApgoing instrument was acknowledge before me
The for oing instrument was acknowledged before me
thisdayof 20by
thiQdayof,� �� 20�by
],A S► er' .
zC� f rti�a�r
(Name of person acknowledging)
1-hw4 U
(Name of person acknowle g )
(SignafQ4hJf Notary P lic-State of Florida)
(SignatuA& Notary blic-State of Florida )
Personally Known OR Produced Identification
Personally Known _L0_ OR Produced Identification
Type of Identification Produced 0
Type of Identification Produced
Commission No. }'�'"q'I )�i (Seal)
Commission No.�a mg (Seal)
rp„ HOLLY BURGESS
Revised 07/15/2014 'o °l .,OLLY BURGESS
„� , °•: Notary Public - State a1 FloridaFlodda , ,r�oY„ of
' • cominisslon a FF 211412 'o °��: Notary Public -State
cc 412
REVIEWS
'ham11po.' rdy con
m. Ezpues ar
rt
E. • • •_
,�� • •= M
Tres Mar
8,2019
FRONT %�13R17N0iondedr
NS
�tuN
OVE
COUNT
R I
REVIEW
B
E�J(°
DATE
COMPLETE
INITIALS