HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED L� 9
Date: ' T7' Ito Permit Number:ILo l/�J
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Building Permit Application FEB 2 9 2016
Planning and Development Services PERrOITTING
Building and Code Regulation Division St. Lucie o nty, 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
PROPOSED WRO►VEMENT,LOCATION _
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Address: L!)'-1'SZ
Legal Description:
Property Tax ID#: C'(n -- L/ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
1),ETA OF WORK. :,"
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CONSTRUCTION INFORMATION.:
Additional work toe e orme und- t is permit-check a appy:
HVAC 11 Gas Tank Gas Piping _Shutters Windows/Doors
L;MElectric 0 Plumbing OSprinklers E Generator 0 Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ L��0 Utilities: 0Sewer O Septic Building Height:
OWNER.LESSEE ' =' :.CONTRACTOR ,';:
NameF S Name:
Address: l , At , `�� Company:
City: r a—Q- State: Address: 010 (A-')
Zip Code--34- "9 Fax: City: I e cL �, State: �1
Phone No� t7- �Z-5J 25 Zip Code: 3t'iCl.tYZ Fax:1 I/.-4 of-q(&5
E-Mail: Phone No gin
Fill in fee simple Title Holder on next page(if different E-Mail: , sz1'Y1Q��rYlc l c�� C'(4 , clo
from the Owner listed above) State or County License: CC,1 I LP43
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTROCTIA.N.LI,EN'LA1N INFORMATION:
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 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.
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_Signator o wnerJ Lessee/Agent Signatu�tractorJticense Haider
STATE OF FLO IDA �4')
STATE OF FLORIDA � i �� 0,
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COUNTY OF C, -- COUNTY OF 'S(
The forping instr me t was acknowledged before me The forgf ing instr �nt was acknowledged before me
this ay of — 20 iby this ay of a 20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifictat�ion Producceejd Type of Identification Produced
Commission NoA"'�" a /10 sion No����Q AR,
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DATE
COMPLETE
INITIALS