HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /
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Building Permit Application MAR 18 2016
Planning and Development Services PERMITTING
St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: so 'Z(X;]�� �/1�` .j 1&
Legal Description:
V
Pr pertyTax ID#: .3-a 7- 7o? 00/�4/ 01 0;3 Lot No. AID
Site Plan Name: Block No.
Project Name: Tk -bi
Setbacks Front Back: -t---Right Side: Left Side:
DETAILED DE�SC«RIFT(ON OF WORK:
CONSTRUCT ON INFO MATION:
Additional work toe e orme under this permit-check a appy:
HVAC 11 Gas Tank ❑Gas PipingMGenerator
Shutters ❑Windows/Doors
11 Electric Q Plumbing Sprinklers E] Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ � �o Utilities: Sewer E]Septic Building Height:
O �R/LE�S�SzE. CO ACT®R.
Name Name:
Acicl s: �a� Company: 'Z�C
City: State: Address _&10 73
Zip Code: Fax: City: State:
Phone No.72.E-1,,3 Zip Code: .3�' Igla Fax:_�Z 7--i - 7
E-Ma &---MJji ktYe_f- Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: e_t7X't-
from the Owner listed above) State or County License: ��.. 74/
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
�PPLEMENTAL CONSTRUCTION LIEN LAW 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 inspe o . f you intend to obtain financing, consult with lender or an attorney before
commencingwork o re 6 din our Notice of Commencement.
. XS06�1_� - s
_Signatur of O e L s gent Signatur of Contractor/License Holder
STATE F ORI STAT OF FLORIDA.
COUN O (�C.r7 COU TY OF
The forgoing instr e_nt was acknowledged before me The for ging instrument was acknowledged before me
this L' day of 20/ b by thisof 20 /6 by
(Name of person acknowledging) (Name of person acknowledging)
(Sig ature of Notary ublic-State of Florida) (Sig6t of Notary ublic)State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced identification
Type of Identification Produ P17& Type of Identification Produced —
OM
Commission No. � ? OI�ery
�Q�:Febru 5,2020 Commission No. (Seal)
Son M Tluu NOW Pubk Ueda m'bra
317 it=
Revised 07/15/2014 "' a EXPIRES:August 12,2018
oE' °p' Banded Thru Notary Public Underwriters
11 s
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
PORCH ENCLOSURE
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