HomeMy WebLinkAboutBuilding Permit Application ALL APP CABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED II
Date: Permit Number-,.....1 7 a
Building Permit Application
DEC 0 8 2015
ING
Planning and Development Services PERlJiIT
Bullding! nd Code Regulation Dlvlslon St. Lucie County, FL
2300 Vir fibid Avenue,Fort Pierce FL 34982
Phone: 772.)462-1553 Fax:(772)462-1578 Comm rcial Residential
PERMI APPLICATION FOR: To Select from drop ox, click arrow at the end of line
Address:' 11 1/
Legal Description:ME k5WD ( ll9
MnDn
P perty Tax ID#; V P B Lot No._
Site Plan ame: Block-No-
Project N' me•
Setbacks; Front Back:_ Right Side: Left Side:
AIC. Vgm66 . cup (Lsf 41A9 f., Vr-
2 C:q
Adid. 1tioh =NNE
wo ro e e Orme -un ert is per —c ec apply-
HV' I[
C Gas Tank. []Gas Piping _Shutt'ers Windows/Doors
Ele' ric Plumbing Sprinklers Generator Roof
Total Sq- t of Construction:' Ft.of First Floor:
� � Utilitie Sewer Se tic Building Height:
Cost of C nstruction:$' r _ _ p '
Name F Name:
Address:: i Company.
,City: � State: l Address:
Zip Cv D o Fax: Ci tate: e°
Phone Ztp Code: Fax:
E-Mail- Phone No,
Fill in fed simplAtle Holder on next page(If different E-Mail: aL� +
from the;Dwner listed above). I State o County License: dl
If value of onstruction is$2500 or more,a RECORDED Notice of, mmencement Is required.
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DESIGNS ENGINEER: _Not Applicable ORTGAGE COMPANY: Not Applicable
Name• ame•
Address: ddress:
City: State: _ ity: State:
Zip: Phone-, Zip, Phone,
FEE SIM LE•TCTLE 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 Is uance of a permit.
St.Lucie Ca mtyy makes no representation that is granting a permit ill authorize theermit holder to build the subject structure
which is in onflict with any applicable Home Owners Association r es,bylaws or andcovenantsthat may restrict or prohibit such
structure, lease consult with your Home Owners Association and r view your deed for any restrictions which may apply.
In consider:tion of the granting of this requested permit,l do here agree that I will,in all respects,perform the work
in accorda'ce with the approved plans,the Florida Building Codes d St.Lucie County Amendments.
The followil ig building permit applications are exempt from underg Ing a full concurrency review:room additions,
accessory s:ructures,swimming pools,fences,walls,signs,screen ri ams and accessory uses to another non-residential use
WARNINTO OWNER.,Your failure to Record a Notice of ommencement may result in your paying twice for
improve ients to your property.A Notice of Commence nent must be recorded and posted an the jobsite
before th efirst inspection. If you intend to obtain financ ng,consult with lender or an attorney before
commending work or recordOgy2ur Notice of Comm endement.
5igndture 'f Owner/Agen Lessee 5 ignature of Contractor/License flolder
STATE O FLORIDATATE OF FLORIDAi
COUNTY• F. FJ iy\L OvNTYOF ice-'
Theoir g in k wledge fore me he fgirgoing in ru e t w s a knowtedged before me
this !ay of 20 by ' tis day bf 20hy
(Name of p son ac owls ging) (.4a me of persoh acknowledging)
(Signature of Notary Publ' -State o F rida] !Signature of Notary Pu c-State Florida). .'
Personally, sown. OR Produced identification ;ersonally Known OR Produced•identification-
Type of identification Produced' I pe of Idehtification Produced
Commissio i No. •`' I) r9st(a No. .
( tY$TA4 MARIE UZAQ0 ' CRYSTAL,MARIE C p0
1rfY�MM Comm i�EE 114113
�"X59 EXPIRE$June 24'.ZOl s .• E"ES Jung 28,2 6
Revised-07/15/2014 -- pari -01W
REVIEW, FRONT ZONING SUPERVISOR LAMS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REViEW VIEW REVIEW. REVIEW REVIEW
DATE
COMPLET
INITIALS
. I
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