HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
Building Permit Application FEB 0 3 2016
Planning and Development Services PERIMITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578Commercial Residential,
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line V30
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PROPOSED. '1'2
Address: -7(y:2C'1 ZA)6-:7 rb PICZ)
Legal Description:
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Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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HVAC Gas Tank ❑Gas Piping _FIShutters [2_W_indo'wsj1Doors
Electric Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
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Cost of Construction:$ uti!;tin Sewer F—Septic Building Height:
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Name if-pu e)L L :5 012&4_ Name:
Address:-/&_?9 Company,'Z_ J_,4_C000Lf-CS�A Q_
city: 511 Luc, *
i e W,e-�-f—- State: FZ_ Address:
Zip Code:•✓ Li to Fax: city:tk) CJ�1' State:-F—'--
P17 3(op Zip Cocle3sq I D Fax: 5_6 I
E-Mail: Phone No. 5-b/ 44 0:571-p-
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: 0 G 0 0 a2L-a
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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 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
commencin ork or recording our Notice of Commencement.
/W s s
_Si na__ _o _ _wner Lessee/Agent tune a ontractor/License Holder
STATE OF FLORIDA 0; - STATE OF FLORID"
COUNTY OF _ ,g -�5r G uti E COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instru t was acknowledged before me
this�day of �i'�m t5 �e.• 20 tS by this / day of Fe .2014:,_by
(Name of person acknowledging) (Name of person acknowledging
(Signature of-N.otary Pu61ic=St� ate`.Qf Florida) (Signature of otary Pubtic-State of orida)
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Personally Known t,"'� OR Produced Identification Persona ly Known t-r" OR Produced identification
Type of Identification Produced Type of Identification Produced
gYP Q�t,yPUg�f ANGELAYOUNG
Commission No. Fr 900 76ITRICIA SUE SMI mmission No._ ° COMMISS{t1l951069
MY COMMISSION#FF9005 6J w z EXPIRES:April 12.2020
EXPIRES:July 17,2019 bonded Tin Budget Notary Ser*m
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS