HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO (MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _
Date / L'L Permit Number: �� f •� 53
RECEV!11177`�
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Building Permit Application DEC 2 1 2015
Planning and Development Services
Bailding and Code Regulation DivWon
2300 Virginia Avenue,!"ort 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
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Legal Descr ption:
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Property Tax ID##: Y - Lot No.�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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it3ona or to MGasTank
orme under this permit—c ec a appy:
VAC Gas Piping _Shutters Q Windows/boors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:_
Cost of Construction:$ Utilities: Sewer Septic Building Height:
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Name % Name- (04
Address: ft�� Company:
City: State: V Address:
Zip Code: Fax: City:Phone No.No. 7J ]�L�UC,W •� ,ri Zip Code: 7,k4' Z Fax: ::1-]2- W lLaS I
E-Mail: Phone No,-:n
Fill In.fee simple Title Holder on next page(if-different E-Mail: � C C
from the Owner listed above) State or e0unty License
If value of construction is$2504 or more,a RECORDED Notice of Commencement is required. ���`7
ii 5
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SEEM
DESIGNER/ENGINEER; Not Applicable MORTGAGE COMPANY: _Not Applicable
Name;, Name:
Address: Address:
City: State: City: State:
Zip:_ Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: `Not Applicable BONDING COMPANY: Not Applicable
Name: _ Name:
Address: - - Address:
City:- _ City:
Zip: Phone: Zip: _ Phone:
I certify that no work or installation has commenced prior to the Issuance of a permit.
St.Lucie County make$no representation that is granting a permit will authorize the permit holder to build the subject structure
which Is in conflict with any applicable Nome 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 de 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
imp ovements to your property,A Notice of Commence ent must be recorded and posted on the jobsite
bef a the first inspection. If you Intend to obtain financi ,consult wit lender or an attorney before
com encing W94Hm"4m4arding y4r.Notice of CQmmenc ent.
Slgnat re of a see Slg ure o Co tra ce se Bold
STAT OF F O STA E OF ORI
COU O COU OFt
The forgoing instrument was ac mowledged before me The forgoing insVi&pent was a knowledged before me
'this�•,day a 20�by this day of z0 y
Loyz)-\ A P,�Wqj�,sd
(Name of peron acknowledge ) (Name of perso acknowledging)-
Id
gnature of N i�r:P' ^y.f�t � ,Fylgda}Stale o larida nature of tart'P _
. My C�gym.Expires Jul 22.2017 df til { Y hlic State of Florida
w: M Comm.Expires Jul 22,2017
Personally Known ��Pro l3dent#i1% 92 Personally Known uc q8 ftA 0Vgjp naasm,
Type of Identificatl n PrY1dtY e Type of Identification .d(ite°d�Y�``�
Commission No R�L (Seal) Commission No. _., (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGE=TATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS