HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
Building Permit Application AUG O'� 2015
Planning and Development Services PERiUi1T1'(NC
Building and Code Regulation Division St. Lucie CO
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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
PROPOSED I'MPROVEMENT.LOCATIONN.:.;
Address: .
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION,OfF WORK t..
CONSTRUCTION INFORMATION
Additionalworkto a er orme d under this permit–check a appy:
VNI HVAC Gas Tank []Gas Piping _Shutters ❑Windows/Doors
LjElectric 0 Plumbing Sprinklers 11 Generator Roof
Total Sq. Ft of Construction: _ SFt.of First Floor:
Cost of Construction: $ — Utilities: _Sewer F-Septic Building Height:
OWNER/LESSEE CONTRACTOR:
Name/K&1-119 g.-), 4. -i_CZA14!:
Address: S . � •S / �.� Company: '4/l'
City: PD State:�. Address:
Zip Code: Fax: City: Stat'e'-
Phone No.777_-JL3.E Zip Code:c3�<fZ92 Fax: 7 7,2-o;zk7�;2741
E-Mail: Phone No.-7 ,2.. to?k /14
Fill in fee simple Title Holder on next page ( if different E-Mail:v<<//SC,L'3va�� �_�sZ'�/-"&[
from the Owner listed above) State or County License:
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCl"ION;LI;EN LA_1N INF.ORIVIATION
M ti
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 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 our Notice of Commencement.
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Y'4�_ &az >
_Signature of Owner/Lessee/Ag t ure of ntractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this (o day of 20 [3ffl_;�_by this_CQ_day of S ! 20 _L5_by
1
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-Soto of Florida ) (Signature oT148tary Public-Statelorida )
Personally Knossy'�JeowV le o e n :p,. ~ Y Q. piX P[tt� 2rA
rl �P x ` �� �, �1 Fersonall Known Ogg n g uced Ide
Type of Identifi tl" tPs�d�t�c r �' d Type of Identification Pro -
• • = : : Commission#F!Nottary
5
epl�ol J to 8181S-ollQnd�S�elo ,,,,���..r•: ;N, ,
Commission N A]N►(M7 71�7111i�Q Se u�n�;°� -f Commission No. %+. �O•� My CIxpires J019
"�� Bonded through NationaAssn.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS