HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
pate: •� Permit Number: (0' ,)J(5)
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Aven ui?,fort Pierce F4 34982
Phone:(772)462-1553 Fay: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address:
Legal Description: Ind �`10ft'S
Property Tax ID#-. 12)MI Sod- 0031- 000- s Lot No. (_
Site Plan Name: Block No.
Project Name-
Setbacks Front Back: Right Side: Left Side:
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itiona work tqe Performed under is permit—check a appy:
HVAC L]Gas Tank 0Gas Piping M_Shutters E]Windows/Doors
EI
Electric 0 Plumbing Sprinklers Generator LJ Roof
Total Sq.Ft of Construction: S , Ft.of First Floor:
Cost of Construction:$ LkCRG.W Utilities:tn
Sewer[]Septic Building Helght:
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Name esa Po f r11 Name: Nodhipil CLI'd
Address: dt f �b t r Company:
City: -+4rLeStater Address: vc',e 0Af
Zip Code: Fax: City: )--� LQr(e --State; PC..
Phone No. Zip Code: 3H946, Fax:
E-Mail: Phone No. - C{ln l-1000
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: 161U411
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUGtION LIEN LAW INFORMATION:
DESIGNERANGINEER: _Not Applicable MORTGAGE COMPANY.• Not Applicable
Name• .. Name• T"
Address.• Address;
City- State: .._ City: __- State:
Zip: Phone: Zip: Phone:
FEE SfMPLE TITLE WOLbER: 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 Count 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 MhCurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER;ifour 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 our Notice of Commencement.
s
Signat a of wrier Lessee/Agent Signdfure of Contractor License Holder
STATE OF FLORIDA C- STATE-OF FLORIDAc-` • •
COUNTY OF ILL COUNTY OF. _____- _L� ( e
The g instra was cknowied ,before me The Wf - instru r�was acknowled a)� fire me
this_"y of n 20�by this of ' 20 r.3 by
borh A— 61LA-.
Woem ackn edging) (Name f person aG wledgin I
�
tgnatu Nota Pu �c- to of Florida) (Signature of to ub i to of Florida)
PersonafTy Known OR Produced Identification Personally Know dR Produced ldentfficatEon
Type of identification Produted Type of I c
;; TR KAY LANGEL e: "I AsM• KAY LA
Commission No. + '
• MY CQMN)IlSSION FF�48o72 Commis s` ION*FF-i 8072
F-9 August goy 201 kXPiAZ19 August SO 2078
sa RiendeNott► eaNlce.00 iaor;3W.0',J F• ,• -
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE: MANGROVE
COUNTER REViEUV REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS