HomeMy WebLinkAboutBuilding Permit Application ,-.LL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
. m
RECEIVED
Planning and Development Services Building Permit Application DEC 012015
Building and Code Regulation Division PERMITTING
2300 I Avenue,Fort Pierce F4 34982 St. Lucie County, F
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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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Address:
Legal Description:
Property Tax ID#: -00a- Lot No,
Site Plan Name:
Block No.
Project Name:
Setbacks Front. Back: Right Side: Left Side:
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HVAC I Gas Tank []Gas Piping _ Shutters Windows/Doors
CElectric 11 Plumbing Sprinklers Generator 0 Roof
Total Sq. Ft of Construction: S cL Ft.of First Floor:
C45t of Construction:$ Utilities: Sewer USeptic Building Height:
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Name:
Company: 5e �vag 16
City:_ _ State: FL- Address: `) a 1 'v5�(�'ot1 Ire 3
Zip Code: ��� 2 Fax: _ City: Fop RO'ee-
Phone No. '71 =�(C-3p�'�! '
Zip Code: 3 State:`�f Fax: 1l %1G `3o�S3
E-Mail: Phone No° 772
Fill in fee simple Title Holder on next page(if different E-Mail: 7LSc' . C"pRSf�lytf� p
from the Owner Listed above) State or County License: JG . ,(
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 TITLEHOLDER: 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 represent tion 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 nQn-residential use
WARNING TO OWNER;Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to you propertyeour
Notice of Commencement must be retard and posted on the jobsite
before the first insp ion. !f yontend to obtain financing,consult with len er or an a arney for
commencingwork ecoi in otice of Commencement,
_Signature a ner/Less e t Signature of Con ctor/Llcens H e
STATE ORI STATE OFF ItIDA
COUNT F COUNTY O
The o �g instru e s kn�ledgJdre�me Thea ng instru a nowiedged ore me
this EKd of 20 —,by this (,..—. �/of.— 2Q
1 ! �
*Perscanall
arson lcnowled ng) {Name of n acknow ng)
TTI c tate of Florida.) {Sign Pts -)
own OR Produced Identification Personally K _OR Produced identification
ratification Produced Type of identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07115/201 F.
' TRACY KAY I�Ni`.ti61.
` MY COMMi5St4hiF 1
41; z '• AMA y ' l" 48072
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REVIEWS - A ,' M ►ON Ft SR sa iS£a�r�UR LE MANGROVE
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DATE
COMPLETE
INITIALS
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