HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE 70 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Ila Permit Number: �
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Building Permit Application FEB ? 4 2016
Planning and Development Services
80ding and Code Regulation Division LuciePERMITTINGunty,
2300 Virginia A ven ue,Fort Pierce Ft 34982 St. Lucie County, FL
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential _
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Legal Description: LIC W
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Property Tax ID#: - 7 1 ( Lot No. �Site Plan Name: Block No. _
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Add—Itionalworictobeoertormea un er t is permit-cheCK a t appy:
HVAC Gas Tank ❑Gas Piping Shutters ❑Windows/Doors
❑Electric ❑Plumbing ❑Sprinklers ❑Generator ❑Roof
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 'L t7 � Utilities:❑Sewer❑Septic Building Height:
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Name .1'Ea-.� Wit: ��z, y Name:
Address: %03� CtT'2k.)�) i7�1�1C V� _ Company: G'A`t���2� R�`2 C�v`l1J►'r f[�Y`ll Ili C-11
City: 0'2T E�1C.fLC�. _State: Address:_l�% f RAST• SS gY
Zip Code: ,�L1Qt1 Fax: City: State: 15:�
Phone No. �� rJ�Ja �?�2.� Zip Code: 27,01 _ Fax, 7L--- L4 9S0
E-Mail: IC.. ql P1 Q C f)1A Q . OW Phone No._ �b -
Fill in fee simple Title Holder on next page(if different E-Mail: C1 -
from the owner listed above) State or County License: C_ C„S 1�7 7 1L
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 TITLEHOLDER: _Not Applicable BONDING COMPANY: —Not Applicable
Name: Name:
Address: Address:
City: City: _—
Zip: Phone: Zip: Phone:
I certify that no work or installation has cam menced 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.
Thefollowing 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 nonresidential 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 recoraing1four Notice of Commencement.
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_Signature of Own r/ a gent Signature of Contra r/Li a older
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STATE OF FLORIIIA STATE OF FLORIDA
COUNTY OF M 1AV4 i DAI:Nt COUNTY OF YWU'� l► f—'AN51
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 Eby this 1•day of 1� 20 by
(Name of pets n cknowledging) (Name of person k I Ing)
(Signat a of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR PrDduced Identification Personally Known OR Produced Identification
Type of Identification Produced l��i Q�1� ��1 � Type of identification Produced (e�i A
Commission No. `Fir V5�S1 tlp„ (Seal) Commission No. 1 ) (Seal)
ss`pavP�WG�4 INAL.Vfs MAR2 INi Z INALV,,. U` EZ
's MY COMMISSION#FF15151$ c MY COMMISSION#F 51518
Revised 07/15/2014 tblpQFepa ` 1=-XPIRFS August 14,2018 '4 orc� EXPIRES August 1 20'18
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
17/2:a6 ed W-ST29b2ZZ:01 :woad 92:2T TT02-02-r1ON