HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: i L 1 ( '2 _ Permit Number:
RCI :
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` FEB 0 4 2016
Building Permit Application
PEPtJIITTING
Planning and Development Services St.Lucie County,FL
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line 1 1✓Ir1�
PRQ'POSED IMPyyROVEMENT LOCATI;O'N
Address: V
Legal Description:
Property Tax ID#: C��' (S7 96 IQQb0-00 G0 Lot No.� 2_
Site Plan Name: W OZCA rvl_� SicC. Block No. J
ProjectName:
Setbacks Front-4— Back:��Right Side: _Left Side:
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DETA'ILED;`DESCR7IPTI.ON OF WORK
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CONSTRUCTION INFORMATION z
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Additional worK to be nertormed under this permit-check all that appy:
HVAC Gas Tank F-1 Gas Piping _Shutters Windows/Doors
Electric El Plumbing Sprinklers 11 Generator L1 Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Q Utilities: _Sewer Septic Building Height:
4
0,1NNiER CO
NTRt TOR
Name Ckfari A ccler Name:
Address: U ` ompany: SSU
City: State Address:
Zip Code: 24c, Fax: City: State
Phone No. 11f)- 1Sm �-'p Zip Code: �j-4D-Ce Fax:
E-Mail: Aaom i e 1—g,<up-Lci 6 vkce- p'd r e cep hone No.
Fill in fee simple Title Holder on next page (if different E-Mail. %
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPRVR IEN�TA'Li : STRUCTIQ:N LIEN. LAW INFORMATIO:N
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
commencing work or recording our Notice of Commencement.
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_Signature of Ow ssee/Agent Signatur of Contractor/License Holder
STATE OF COUNTY OF ORIDA �ynC)n STATE F COUNTY OF FLORIDA r,Q
Ther oing instr m nt��(as acknowledgeCY
ore me The rgoing instrurr�ent was acknowledged before me
th�ay of 1V 20 thi��ay o��'J���`S); , 20 1 �i�by
add,
(N of pers cknowledging) (N a of person acknowledging)
(Sature of Notary Public-State o Florida) (Signature of Notary Public-State of Florida�); "
Personally Known OR Pro u ed Identification Personally Known L'/OR Produced Identification
Type of Identification Produced Type of Identification Produced
Is DeMra Danielle DeMaria
Commission No. Commission NoC �- ARYPUBLIC
(p ARY
fAPUBLIC t OF FLORIDA
S STATE OF FLORIDA : FF929863
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4 EIS Expires 10/21/2019
Revised 07/15/2014 reE���® Expires 10/21/2019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS