HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t-
Date: Permit Number:
RECOVED
DEC 0 7 2015
- Building Permit Application
Planning and Development Services PE:R[VIITTIW�i �
Building and Code Regulation Division St. Lucie County.. � L
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential t/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of lineskv I
PR' P®SED I„MSP 0MIMi 1ENT L®CA 110
Address: E” CA2-e—, T. r a e--
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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C®NSTRIJCT,,ION IN1=ORtMA�I®N: ,� i, r r
Additionalworkto e e orme under t -checkispermit a appy: I
❑HVAC Gas Tank Gas Piping —Shutters Windows Doors
— ❑ P g Q /
Electric ❑_Plumbing Sprinklers Generator 1:1 Roof
Total Sq. Ft of Construction: ��`� S . Ft. of First Floor:
Cost of Construction:$ r�rb Utilities. _Sewer Septic Building Height:
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OWNER%LESSEE CON¢¢ RACT®R:
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Name` Name:
Address i, to Company:
City: State:._ Address:
Zip Code: - axe City: State:
Phone No.? Zip Code: Fax:
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$2500 or more,a RECORDED Notice of Commencement is required.
Sl1=P'PLEI�IENl'Arl.C®NSl'Rill�l®N LIEN �W I'N`FOR�IVIATI®N:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: i t'` 1' Name:
Addr ss: �-& I Address:
City: State:_L City: State:
Zip: Phone: — — � '2; 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.
v S
_Signature�Cl
wner/Lessee/Agent Signature of Contractor/License Holder
STATE OFRIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The for oing in m nt was acknowledged before me The forgoing instrument was acknowledged before me
this�day o 20/�by this day of 20 by
i
( ar'ne of person acknc wledgin ) (Name of person acknowledging)
(Signature of Notary u lic-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced dentification Produced
.............. KAREN S. NIE SEN
>�pRr vBli'�i
Commission No. � I)Commission N FF 11E6m1 ion No. (Seal)
My Commission E cpires
%E° June 12, 20 8
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS