HomeMy WebLinkAboutBuilding Permit Application OCT-15-2015 THU 01 :09 PM CENTRAL SCHEDULING FAX No. 3212686138 P- 002
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' RECEI'.'rD OCT 161015
Building Permit Application
Planning and Development'Services
Building and Code Regulation Division
2300 Virginia Avenue,Port Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-5578 Commercial_ Residential _
PERMIT APPLICATION FOR' To Select from dropbox,.click arrow at the end of line 0, G
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property7ax ID fit:
Site Plan Name: Bock No_
Project Name:
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1 lona wor to e e rmed un er t is permit—Ctlecl<all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
0Electft 0 Plumbing 05prinklers Generator Roof
Total Sq.Ft of Construction: 5 .Ft.of First Floor:
Cost of Construction:$ �o 13 t� d UtilitiestSewer Sept[c Building Height:
Name \ Name:
Address_ Compan
State: Addss: l
Tp Code: 5 Fax:Y cityp_ U I C State:
Phone No. 5 ` zip Code: u • Fax•'T)1_g1tb
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E-Mail• „ Phone No. �
Fill in fee simple Title Holder on next page(if different ' E-Mall: l
from the Owner listed above) State or County lice
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
OCT-15-2015 THU 01 :09 PM CENTRAL SCHEDULING FAX No, 3212686138 P. 003
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DESIGDI:R/t:NGINI�I:R: _Not Applicable NiORTGAGECOMPANY: Not Applicable
Marne: Name:
Address: Address:
City: State: City: State:
Zip: __-- Phone; Zip: _ Phone*,
FEE SIMPLE TITLE OLDER; 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 ermit will authorize the permit holderto build the subject structure
which is in conflict with any applicable Home Owners AssocrAon rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consuit with your Home Owners Association and review your deed for any-restrictions which may apply.
In consideration of the granting of this requestedpermit,i do hereby agree that I will,In all respects,perform the work
in accordance with the approved pians,the Florida Building Codes and 5t.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-residenr al use
WARDING 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.
Signature f Ow J Agent{Lessee Signatur of Cont or/License Holder
STATE OE VLORID STATE OF RIDA
COUNTY OF. �,J� . � �� COUNTY OF
The f Ding instr w a k Id The ore me The fo aIng instr a was acl )owledged�refore me
this``` day of! �� 20 by this day of�� ,2d by
(Name of person acknowledging) (Marne of person acknowledging)
(Signature of Notary Public-State of Florid (Signature of Notary Public-State of Florida
Personally Known OR Produced Identification Personally Known OR Produced identification
.Type of Identification Produced Type of identification Produced]
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS