HomeMy WebLinkAboutBuilding Permit Application SCPPLEMENTA�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 1 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 N tice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you ' end to obtain financing, consult with lender or an attorney before
commencingwork o ecor ' our Notice of Commencement.
S
_signature of Owner/Lessee/Agent Sig re df Contractor/Lic6bse Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledgfp before me The orgoing instrument was acknowledged before me
this day of 20by this T day of 20 by
(Name of person acknowledging) (Name of person cknowledging)
(Signatu otary I5ubIiJZfaTe of Florida) �igonatu�reejtary ublic-S e o Florida )
Personally Known OR Produced Identification Personally Known %0 OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. eal) Commission No. C' p+ (Seal)
gin
HOLLY BUR ESS
liotai;Pvhlic State of Florlda_
Revised 07/15/2014 .�; ommisc F 211412
F,ILLY BURGESS
sem., 4 nAy Comm xor-Is Mar 18,2019 ;:°`, :`c': Notar;Public-State of Flo a
ry
REVIEWS FRONT S VEGETATION 1, LWe
y C $ 18, �9
COUNTER REVIEW REVIEW ..REVIEW REVIEW
...... . ...... .
DATE
COMPLETE
INITIALS
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
r
Date: Permit Number:
ii:rr - n
Building Permit Application AN 12 2016
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 343$2
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end Of line
PROPOSEDIMPROVEMENT'LOCATION:
Address:
Legal De ription: 1/ " I,} at4
Property Tax ID C)OLot No. G��
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
pETAiLEC'>DESCRIPTION OF WORK:
Wn
CONSTRUCT 9*kNFORMATION:�
Additionalwor to . e e orme under this permit–check a appy:
0HVAC0 Gas Tank Gas Piping _Shutters Q Windows/Doors
11 Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ "'—" Utilities:[]Sewer Septic Building Height:
OWNERAESSEE:' -CONTRACTOR:
Name Name:
Address: E Company: k.
City: Q__ e�tState Address:
Zip Code; e) Fax: City: Sta eN
Phone No. – ��,--�lo1 Zip Code: Fax:
Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: - `
from the Owner listed above) State or County License.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -�-� Permit Number: Z(aat 4- 0�2 1.1
Building Permit Application AN 12 2016
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: ('
Legal De ription: " V
Property Tax ID#: ^ �� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
F4 a9ki�
DETAILED,.DESCRIPTION OF WORK:
CONSTRUtT1ON1 11FORMATION:'
Additional work to be pertormed under this permit-check all appy:
E1HVAC Gas Tank Gas Piping Shutters Windows/Doors
1.1 Q
Electric IX-Plumbing Sprinklers MGenerator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ UtilitiesbSewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name:
Address: �,__ a Company:
City: CA��__ State-M Address:&2
Zip Code: _0�\ Fax: City: S Sta e:�
Phone No. Zip Code: Fax:
E-Mail:,gC/Y Q /Y1 if V,4�47-, G0/71, Phone No. `
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.