HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST)BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ol• / Permit Number: zip 00, '0_Z?
RECEIVE®
Building Permit Application FEB 16 2016
Planning and Development Services
Building and Code Regulation Division
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
PROPOSED IMPROV MENT LOCATION
Address: t(11
Legal Description:
PropertyTax ID#: O Z Lot No.
Sitee-P-lan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK. ;"§
CONSTR,UCTIO'N;I N FORMATION
Additional work toe e orme under this permit—c ec a appy:
HVACank ❑Gas Piping _Shutters Q Windows/Doors
Electric L41Paumbing nU pS rinklers Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ � �. Utilities:ll Sewer 0 Septic Building Height:
OWNER LESSEE: CONTR CTOR
Name �cQ Name-
CA I
Address: 'C Company: A if
City: State: Addr s:
Zip Code: D Fax• City: i P e State:
Phone N -7&33 Zip Code: Fax:
E-Mai . D Phone No-77,4( to 144� /5
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.
SUPPLEMENTAL CONSTRUCTION`LIfNLRW INFORMATION
p —Not Applicable
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:
Name: Name:
Addr-ess: 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.
--im-e 2�1- s
_Signa re of Owner/Lesse /Agent SignatLA of Contractor/LicgKse Holder
STATE OF FLORJDA STATE OF FLOWA le
COUNTY OF ,1��L COUNTY OF 1:ndw,1_t
The fo oing instru a was acknowledged before me The for oing instr e t was acknowledged before me
this day of 20Vkby this M day of -1W 20 4L by
(Name o rson ac now edging) Zam perso acknowledging)
Y,/
( ' n ure oYlQwy Publi S to of-Florida re o o lic-State of Florida)
Personally Kno OR Produced Identifica ' Personall OR Produced Ident on
T ntification Produced pe of Identification Produced
Commission No. SezIJJ p yaKING Commission No. ,a:'•y•., ERNA KING
r0.•' ?
MIY COMMISSION 0 EE 877248 � .: MY COMMISSION q(E Sj1248.,
"�. EXPIRES:Ma 4 2017 va? EXPIRES:Ma 4 201T
on ru Diary Public underwriters "fi R�.,,.° f Bonded ThruNotuy Public Underwriters
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS