HomeMy WebLinkAboutBuilding Permit Application KLL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: •C(o Permit Number.
RECEIVED
Building Permit Application FEB 0 5 2016
Planning and Development Services
PFP,'MIiTTING
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
PROPC?SED IMPRDUEMENT LOCATI®rNa
Address: EICo ;L0(0 y�o c"e q
Legal Description: C4 0^•A Oce
Property Tax ID#: ate Soo -� 03'" -a Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additionalworkto a e orme under this permit-check_ a appy:
HVAC Ei Gas Tank Gas Piping _Shutters Q Windows/Doors
11 Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: t� S Ft.of First Floor:
Cost of Construction:$ g(Dg !. O0 Utilities: Sewer[]Septic Building Height:
�WERESSE 1. ONiJR•:i CON RAGCCTad
Name z Name:
Address: ,rc� a(o Company:
City:. WC.."L State: -;�L✓ Address:
Zip Code: "J i Sa-- Fax: City: 61altswBeaM.FL33483tate:
Phone No. ^1-1 �,-�`Z�-5 S_ Zip Code: Fax: q>___�f Ltaaci`i"')a
E-Mail: Phone No. -c S9 a Colo
Fill in fee simple Title Holder on next page(if different E-Mail: 1 a
from the Owner listed above) State or County License: a
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
IESIGNER/ENGINEa:
UR LEMENTAL COIV:wRUG* LIEN LA11V INFORMATION _:. its' i"'�`=7,i._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.
s
_Signature of Owner/Lessee/Agent Signature o ontractor/License Holder
STATE OF FLORIDA STATE OF FL9�IDA
COUNTY OF ��'- Lac �� COUNTY OF FLT
%V%,
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this BIL4 day of 3" , 20 «by this a-9 _day of a ,20 (,b by
14
(Name of person ac owledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known C RUM—
cation Personally Known�_OR Produced Identification
Type of Identification Pro duType of Identification Produce
is State of Florida o+�`Y°�y Notary public State of Florida
Thomas �R ThomasCommission No. ssio i.FF 00823a Commission No. s CortfmissionFF008234
15/2017 1ki OFno� Expires 04/15/2017
Revised 07/15/2014
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