HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 I
Date: Permit Number:
F-al E C,FH 11V 17131
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Building Permit Application APR 0 9 2016
Planning and Development Services
PERMITTING
Building and Code Regulation Division St. Lucie County rL
2300 Virginia Avenue,Fort Pierce F134982
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
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~P .OSED.�IM�P V�EM�E•NT O AT 0 � Y=:
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Address:
Legal Description: QD(cU_n IPb/l s 19,9U ( ±IC rhnc
Property Tax ID th 06"2'�56 60�7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to bflertormed un er t is permit-c ec a appy:
HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric ❑Plumbing Sprinklers a Generator Roof
Total Sq. Ft of Construction: ?6 Y S . Ft. of First Floor:
Cost of Construction:$ ��/So, 6o Utilities In Sewer[]Septic Building Height:
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Name Name: �S '... +:•.�
Address: g?Q Q ,('o Company:A I f m A'
City: State:EL Address: ( us
Zip Code:_ JL(� 5 Fax: City: IrCe Stater
Phone No. Li-20 Zip Code: Fax: 77-7-LI6q-0600
E-Mail: Phone No. 7 ,De q-(p DO
Fill in fee simple Title Holder on next page(if different E-Mail: `
from the Owner listed above) State o County License:_CCG 13Z I27
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 TITLE HOLDER: —Not Applicable BONDING COMPANY: _Not App licable
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 appl y.
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
cornWrIcing work or recording our Notice of Commencement.
St ture of Owner/Age t/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDAIl
COUNTY OF 15-� - I COUNTY OF 5-• �uQ_k_e�
The forgoing instrument was acknowledged�efore me The forgoing instru ent was acknowledged before me
this 2 day of, r 20 1 by this�day of r; 2014 by
Y k/J-3 �Ces lc' A
(Name of person acknowledging I, (Name of person acknowledging) °`: '�;B`% JENNIFEROBERT
* MY COMMISSION#EE 215904 * * MY COMMISSION#EE 215
EXPIRES:November 12,2016EXPIRES:November 12,2
Nj9re F_ eO` BondedThru Budget Notary Services \.e a���1 � OFF� BondedThruBudgetNotaryS
C
gn ure of Notary Public-State of Florida) ("gn ture of Notary Public-State of Florida
7� )
Personally Known '� OR Produced Identification Personally Known VI" OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS