HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: •�S Permit Number: �j� ^ oto
RECEIVED
Building Permit Application MAY ' 2 2015
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 Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Property Tax ID#: 03- 031;-000-�i Lot No. ^�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be performed under this permit–check all t=appy:
HVAC L_J Gas Tank ❑Gas Piping _Shutters a Windows/Doors
Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Costo truction:$ \—I;H� Utilities:)Sewer Septic Building Height:
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N eL'� VnC� �Ls+ �- ,1�y Name: v�n�
Address: Company: tics Ctin ��►� Q�kh��r
City: State:_ Address: 31 h 0
Zip Code:_ 3�t%�SZ Fax: City: QnA State:
Phone No.1-Di T13-5411 Zip Code: 39okgqp
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:
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 thepermit 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
commex ing work or l:ecording your Notice of Commencement. A
S' nature of wrier/Age Lessee Sign ture of Contractor/Licens older
STATE OF FLORIDA �..; STATE OF FLORIDAr .
COUNTY OF COUNTY OF L:%: ✓°
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this-'_>i' day of /)L4?w 20 by this I____/9day of i r `''- "
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- EXPIRES May 05-20161
(Name of person acknowledging) (Name-of personf ing) 00.0"'
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(Signature of N6tary Public-State of Florida) (signature of,Notary Public-State of Florida)
Personally Known 1`'. OR Produced Identification Personally Known OR Produced Identification
Type of Identification PType of Identification Produced
TDak4G StCKYCommission Na�'Y"'�{' :t:' ''' Mi'CSICMd#EEiif393 Commission No.t'`= � ' t •� (Seal)
EXFnRFS May 05,2016
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
CO M P LETE
INITIALS
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