HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application JAN 2 1 2016
Planning and Development Services
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie C ty, FL
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: 11.5'5 /l/e 1451It S
Legal Description: d/►
Property Tax ID#: --,701 - /35/1- 000 - Lot No.
Site Plan Name: Block No.
Project Name: /�i4s✓ Jr �dJ�S 1r
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIP7IONO�F WGORK + f ` J � f '' � ' }' s
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CONSTRUCTION INFORMA4TION 4 _
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Additional work toe performed under this permit-check a appy.
HVAC F]Gas Tank ❑Gas Piping _Shutters Windows/Doors
0 Electric M Plumbing 0Sprinklers E Generator oof
Total'Sq. Ft of Construction: `SO 0 S . Ft.of First Floor:
Cost of Construction:$ 1, 7 0 Utilities:CnSewer Septic Building Height:
OW)VER LESSEE
/ ; CONTRACTOR >�
Name .�,'e/ vhbS ,Te- Name f4•7 Ma 'tol"A ..
Address: 1VG eS g/t/ Company: 09,90 IC coneeoy4s dIC
City: Te- Sedee- Cl.%. State: F( Address: OA( Sdr/ Crry�un _
Zip Code: Fax: City: PSL State:
Phone No. 7,L -T3 Y - 65 ,2 Zip Code: ?f f a Fax:_- 3ry 7�f�
E-Mail: Phone No. ?7.2-31V y --37 17
Fill in fee simple Title Holder on next page(if different E-Mail: ,�yo�conGGa �`nC a l/SovfA-lae �-
from the Owner listed above) State or County License: Ir 2-Y
in
of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL:CONSTRUCTION LIEN.LAW INFORMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE C ANY: _Not Applicable
Name: Name:
Address: A ss:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Nlicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: one: 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.
/_,� s
_Signature of Owner/Lessee/Agent Signature of Contractor/ cense Holder
STATE OF FLORIDA STATE OF FLO �q{,�,;�
COUNTY OF COUNTY OF ct
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 by this 4f day of 20 1 by
(Name of person acknowledging) (Name of person c owledging)
(Signature of Notary Public-State of Florida) (Sign ture of Nota bli -S e of Florida
Personally Known OR Produced Identification Personally Known OR Pdgc�eld Ifl nti�fication �-
Type of Identification Produced Type of Identification Produced
gn
Commission No. (Seal) Commission No ti ��� ibe _U
a KAITLYN LOUPE
°� «`�•: Notary Public-state of Floa
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Revised 07/15/2014 ",OFF" My Comm.Expires Jul 13,2 s
Bonded through National NotaryA n.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS