HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1—�
Date: �9 - � -) n � 6L ANNED Permit Number: 1 l '
BY
�t. Lucie County
Building Permit Application FEB 0 3 2017
Planning and Development Services p TTINLG�
Building and Code Regulation Division S I� c�, i Ey,gL
2300 Virginia Avenue, Fort Pierce FL 34982 to tfulcie County, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial _� Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Property Tax ID
i
Site Plan Name:
Project Name: I
Setbacks Froi
Haanionai work Eo oe errormea unaer Ems permit— n
❑HVAC Gas Tank []Gas Piping
❑Electric ❑ Plumbing []Sprinklers
Total Sq. Ft of Constructions:: —, !D� 15
� Cost of Construction: $ OUIJ •W
•1
Lot No.
Block No.
Left Side:
Shutters Q Windows/Doors
Generator ❑ Roof ❑ Roof pitch
S Ft. of First Floor: _
Utilities:n Sewer ❑ Septic
Building Height:
OWNER/LESSEE °
`CQNtryT�2AG�'OR
Name Grbuor lerc�< P0.4 I
Address: a (o 0 b L�U f4 r ✓r V01
Name: i im
Company:
City: pcv k m c t ±�J Sta e:
Zip Code: � i 4 G Q lo Fax: �
Phone No. -7Ia ��S a�o� 1
Address:C d�
City: �I I /1 SntGatter
ZipCode�'�l(3q--? Fax
Phon o.l - Lnl
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail. D p,_;
-State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
S?PLE(VIN�ALyONSTRtICC10N"LINL/1VitNFQRiV1ATON yt
.r
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone:
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
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
commencine work or recordine vour Notice of Commenrement_
G �
s
as Agent for Owner Signature of Co tractor/License Holder
STATE OF FLOfA ` 0
COUNTY OF ����\\
The forgoing instrument yjas acknowledged before me
this I day of r L 200—by
Personally Known l/ OR Produced Identification __
Type of IdentifFpaMro aced yn—�j
Commission
Revised 07/15/2014
1 ..
STATE OF FLORI.pA�
COUNTY OF FF1i\t
The forgoing instrurmmen11t__was acknowledged before me
this day of 1 7� 20 � by
of
(Signature of Notary Public- State of Florida )
Personally Known ✓ OR Produced Identification
Type of Identification Produced
rn;i!•e BEV L. HADDAD
Commission No. a 'F' �"" I
M S
Af 10MMISSION # GG
EXPIRES: July 6.20
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