HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLI ABLE IN O MU T BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:—412-q Permit Number:
Building Permit Application
Planning and Development S rvices
Building and Code Regulotior Division
2300 Virginia Avenue, Fort P rce 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 DescriptionM ' "ISA Iry-., A- (r)ii-)n rz—1
Property Tax ID #: ^ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front i Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
fibn 1"5 L,,(jt 1.1 [ D K -w
cc cT € N INFC3I tVIATION
it nal wor to jeee orme under this permit — c ec a app _
HVAC L_ J Ga Tank Gas Piping
❑ p g Shutters ❑ Windows/Doors
❑Electric ❑ Plumbing Sprinklers ❑ Generator ❑ Roof
Total Sq. Ft of Construction: Scin of First Floor:
Cost of Construction: $ . Utilities: Sewer ❑Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Na
Y
Name:
Address:1/
Company
Address: u
City
Zip Code: ax:
Phone No. 11
State:
-
,�Q
CitXb�—fes C1�� { Stated
Zip Code: Q Fax:
No.
E-Mail:_n_i aPhone
Fill in fee sil ple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: `e
Stat County License: C-
vrcvw rvornce cr,Lommencement is required.
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DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City.. State
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
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 thepermit 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 recorclogyqur Notice of Commencement. _
Signature of Owner/ AgenT/ Lessee
STATE OF FLORIDA n ,M
COUNTY OF (M L 6
The forgoing instr ment as acknowledged efore me
this% day of 20 acknowledged
(Name of persor}acknoJedgingy
t/
(Signature of Notary Pub ic- State of rida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.^ ft CRYSTAL MAF
Signature of Contractor/License Molder
STATE OF FLORIDA
COUNTY OF
The f, orgoing instru a acknowledged efore me
thi_^�,} day of 20_1"y
1
(Name of f on ac wled 'ng )
1
(Signature of Notary Pu St of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
=1 '•c MY COMMISS N 4 EE197463CRYSTAL
MARIE CRU;
>"„ EXPIRES June 25.2016 ISSION 0 EE1
Revised 07/15/2014 �4M M-0�s3 .� "qf„ • ' EXPIRES June 25.20
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS