HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4. Permit Number: 1(n
RECEIVED
Building Permit Application
Planning and Development Services APR 12 2016
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FC 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential Z —
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
IPROPOCI`�#MPROVEMENT LOCATION:
Address: 3� 04 4
NI
Legal Description:
Property Tax ID#: ( ('? C�p� (.ADO -7 Lot No.
Site Plan Name: "' Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
00MAD OMRfVWN Of WORK
V 01
INFORMATION:
Additional worK toer. e Orme it——5-n-der this permchecka appy:
HVAC G Tank E]Gas Piping _Shutters Q Windows/Doors
Electric _Plumbing OSprinklers F1 Generator Roof
Total Sq. Ft of Constructio .� - So. Ft.of First Floor:
Cost of Construction:$ Utilities Sewer a Septic Building Height:
gY CONTRACTOR:
Name Name:
Address: " J r {� Company
City: V StateV Address:
Cit State.
Zip Code: _
Fax: r Y=
Phone No.qLq � J l Zip Coder Fax
�e�'�l��
E-Mail: Phone No. f
Fill in fee simple Title Holder on next page(if different E-Mail: LW d
from the Owner listed above) State or County License:[g,r tf?
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
��WAL CONMUCTION 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,1 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.
1�/ JR�� < s
_Sign re of Owner/Lesse Agent Signet a of Contractor/Lice Holder
STATE OF FLORWA STATE OF FLORIDA
COUNTY OF -->'f.,L.U.w COUNTY OF
The forgoing instruXnents acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 /4by this day of 20 by
- F, +, &
(Nam f erson acknowledging) (Nam f person acknowledging)
I.��0��I (A �L-C� (1 �Q& I— ri
(Si a ure of Not7OR
- ate of Florida) igna ure of Notary P I -State of Florida}
Personally Known Produced Identification Personally Known OR Produced Identification
Type of Identification Prod Type of Identification Produced
.VIM
+: UBERT!.4 KING '"".''' 11BERTYA KING
Commission No. s*: c� *__ M( (MISSION p EE 877248 Commission No. _*; fie''COMMISSION#EE 8772
a• EXPIRpES:May 4,2017 ., EXPIRES:May 4-2O i
Bonded Thru Notary Public Undenwmers or L 0 Bonded Thru Notary Public u,,ien-,.
Revised 07/15/2014
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DATE
COMPLETE
INITIALS