HomeMy WebLinkAboutBuilding Permit Application FEB-24-2016 WED 08:02 PM CENTRAL SCHEDULING FAX No, 3212686138 P. 002
Date: Permit Number: G Oa p 5
H C E I'.' D FEB 2 5 2016
Building Permit Application
Planning and Developmentservices
Building and Code Regulation Division
2300 Virginia Avenue,fort Plerce rL 3.4932
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION PC R: To Select from drophox,click arrow at the end of line V qC
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Add rens;
Legal Description:
Property Tax 1❑f#: 303 al 1' -000S Lot No.
Site Pian Name: Block No.
Project Name:
Setbacks Front Back: RightSlde: Left Side:
r»rifi�YS�y p 0 Vol IM M
$ p�
1000D
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�lona wor o e e orme un er is permit—c eG a appy:
AC Gas Tank 1JGa5Piping _5h utters ❑Windows/Doors
EjEiectric Plumbing OSprinklers Generator Roof
Total Sq.Ft of Construction: S .Ft.of First Kioor:
Cost of Construction:$ G,a00 a0 O Utilities:]Sewer Septic Building Height:
MIA
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Nam Name:
Addre ` Compa y,
City: State: Ad ss.
Zip Code: Fax: Ci LUCA state,
Phone No.- Zip Cad Fax- -1
E-Mail: Phone rig. �J
Fill in fee simple Title Holder on next page(If different E-Mail.
from the Owner listed above) State or County Lice-Ye-
If
ice eif value of construction is$Z50D or more,a RECORDED Notice of Commencement is required.
FEB-24-2016 WED 03.03 PM CENTRAL SCHEDULING FAX No. 3212686138 P. 003
"EllN. iY:: l:k+,7 n ;tiy P�q �,yq k�yrraYti' ht INER/ENGINFER: �Not Applicable fi MORTGAGE COMPANY: t�' Not Applicable
Name: Name:
Address: Address:
City: State: __ City: State:
Zip: Phone: Zip:. Phone:
FEE SIMPLE TITLE HOLDER: Not Appl]cable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City;
Zip: _ _- Pane: 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 apermit will authorize the permit holder to build the sublect structure
which is In conflict with any applicable Home Owners association miles,bylaws or attd 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,l 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
commencin work or recording our Notice of Commencement.
SIgnat4015 of Ow /Agent/Lessee Slgnature Contra r(Llcense bolder
STATE OF FLORII?AR
STATECOON OF:FLORIDA �(
COUNTY OF COUNTY OF
The Qmg instru nt was acknowledge efare me The �° oing In t� m rit was acknowledg before me
this t�day of`� �D�y this1'`� day of# . --_ r 2CbY
f pay
(Nam of person acknowledging) (Name of person acknowledging)
igttature of Notary Public State F arida) (Signature of Notary Public-Sta o Florida)
.Personally Known OR Produced Identification Personally Known_` C3R Produced Identification
Type of Identification Produced_ Type of Identification Produced
1 i o etlae Konger
Commission Nd 1 IL �;� i&slgp#RF17237�" Commission No F+GC� '`r' titarltteltattge
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