HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:.
RECEIVED
Building-Permit Application JAN 12 2016
Planning and Development Services PERrOITTI NG
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort 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
Address:
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Legal Description:
Property Tax ID#: (5012k OOD-1
Lot No.
Site Plan Name: sck Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be e ormed under this permit-check all that app y:11Windows/Doors
LTJ HVAC Gas Tank [_]Gas Piping Shutters
Electricrolumbing OSprinklers OGenerator Roof
Total Sq. Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ Utilities:[]Sewe'rF�
Septic Building Height:
Name: NP �44N%Xvv%
Name
Address: %svv&
City: State: Address: 31 0'RJyA'_'
Zip Code: Fax: City:_VAA wuk'A_ State.a.
Phone Na. _M_ Zip Code: 341V Fax:11'—)'3I1-q#49
E-Mail: Phone No. Z" 014 014
Fill in fee simple Title Holder on next page"{If different, E-Mail:1?1tyt2AL\1M e - lAf_Ab1de-t"DW%
from the owner'listed above)
State or County License: \41-UIVI
If value,of construction is$2500 or more,a RECORDED Notice of Commencement is required.
e00/100 XVJ ZZ:9T 9TOZ/ZT/TO
' 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 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 l 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 inspediwQlf you intend to obtain financing,consult with lender or attorney before
com cin work or r-lin our Notice of Commencement.
ignature of Own ge see Signature of Con ractor/License Holder
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STATE OF FLORIDA 07- STATE OF FLORIDA
COUNTY OF I COUNTY OF cS7' I•. !,+-Q,
The r Ping instr t was acknowledged j�efore me The fo,-,r��oBping instrtr t was acknowledged before me
this=ay of 44— 20 li by thi May of`! 20J& by
(Nam of person ac owledging) (Name of person ac nowledging}
(SIFAure of 61otary Public-State of Florida} ( ignature of44otary Public-State of Florida)
Personally Known "" OR Produced Identification Personally Known ✓ OR Produced Identification
Type of��� tion Produced TO of identification Produced
�'_ /653
Commission No. , (Sei4E _.T' CP ission No. ""•" ;_ {5KY.T $�r;
*c MY CCSMMISSION.#EE1 4693.'
�` t . MlIiSlOAti�EElil
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
£00/Zooln YVd 99:9T 9T09/9T/T0