HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEb
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fart Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1575 Commercial Residential
PERMIT APPLICATION FOR: To Select from,dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 631L 7 � st'r -
Legal Description:
PropertyTax iD#:_1 J 1--(,y6(o` cap 1;,;C'a Lot No.
Site Plan Name:- _..__.. ._._,._. Block No._.
Project Name: Rontaa ..we
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
ill;) '� 4 r Er �:,fS�IF►� y:,��. �� k t' c � (r'��� Qr k.t,
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CONSTRUCTION INFORMATION:
i rona wor o e e orme under this permit-c ec a-11, appy:
OHVAC f]Gas Tank E]Gas Piping _Shutters Windows/boors
Electric El Plumbing Sprinklers 1:1 Generator L Roof
Total Sq.Ft of Construction: SFt of First Floor:
Cost of Construction: t o
$ `-t�,��. Utilities: Sewer OSeptic Building Height:
OWNER/USSEE: r.. CONTRACTOR:
Nam Name -Q,
Address: Company: kq1 an c 4-
City_ _ . State:_ Address: - --—-----
zip Cade_ Fax: City_ State:
Phone No, zip Code: Fax: _6
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$2.500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER. Not Applicable MORTGAGE COMPANY: Nat Applicable
Name: Name.
Address: Address:
City* Stater 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.
Awhich County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
W Ch is Iniqonflict 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 dead 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 ftill concurrency review-room additions,
accessary stvctures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWN ER-Qyour 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.
s
Signature of Owner/Lessee/Agent SlgWure of Con tractor/1-1cense Holder
STATE OF FLORIDA C, STATE OF FLORIDA----
COUNTY OF LX COUNTY OF, 2J t Le
The f Dtknowledgeo strunwDLWas
g instir"VIT"VS -liffore me The fo n n ar-knowledged-bpfore me
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LAW-.
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,State of Florida) to
'Perso, n OR Produced Identificatlon Personally Know OR Produced Identification
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Type W-identification ProducedType of I
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Commission No. TIR $,ON#rFi48072 Commissl
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Revised 07/15/2014
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DATE
COMPLETE
INITIALS