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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLCEJ INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Datea�I ( Permit Number: I(O© Z.� ^�Ll IT : Building Permit Application FEB 18 2016 Planning and Development Services PERrJ11Ti'ING 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 Residentialy PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line. PROPOSED IMPROVE MENT-LOCATION•. Address: O f_ Legal Description: , o�t.-PbA 1f� ALS ,L63 Cpx_ — 39 Property Tax ID#: —Q Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK CONSTRUCTION INFORMATION. Adclitional work to be nertormed under this permit—check all appy: HVAC Gas Tank Gas Piping Shutters Windows Doors Electric ❑_Plumbing a Sprinklers Generator _ oof Total Sq.Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ OC; 00 Utilities:Sewer F]Septic Building Height: L' OWNER/LESSEE CONTRACTOR. Name Name: �} Address: M C 6 r'• Company: ' e City: State: Address: 14 _ Zip Code: Fax: City: State: Phone No. Zip Code: `Fax: E-Mail: Phone No. Z Fill in fee simple Title Holder on next page(if different E-Mail: t 1 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:LIEN LAW IN,FORIVIATION`: 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 thepermit 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 recordin our Notice of Commencement. 6�x I- I fx�_ A c s _Signat of Owner/Lessee/Age Signature of ntractor/License Hol STATE OF FLORIDA,�/�1 �,b>� COUNTY FLORIDA COUNTY OF �V l 1 /f The forgo'ng instrument was acknowledged before me The forgoing instrument was cknowl edged before me thisof R� 20��by this�y of 20 by i �J (Name of p rso knowledg' g) (Nam f er n acknowl dging) G� . (Signature of N ary� Iryc- tat of Florida)_ (Signature NotaPublic-St of Florida) Personally Knowny OR Produced Identification Personally Known JZCR Produced Identification Type of Identification Prod ;Aq Type of Identification Produced R0p}��� H�AqMPTON "�. �` Commission No. ffiMrcbl�mt3s10N#FF188186 Commission nnnl >� (5 �1j I Rr,ypTON EXPIRES:January 08,2019 ( N,l'C Q! V153ION#FF388186 ROY FRAMPTON ., ;I;.�; January 08,2019 Revised 07/15/2014x„ EXPIRES:January 08,2019 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE CO M P LETE INITIALS