HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: J' -0 I (� . Permit Number:
� f RECEIVED
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Building Permit Application MAY 9 2016
Planning and l evelopment Services
Building and C de Regulation Division
2300 Virginia venue,Fort Pierce FL 34982
Phone: (772)1462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IIVIP,ROVE MENTIOCATION: "
Address: ��� �, 23
Legal Description:
Property Taxi ID#: '�12�- `-�I - - � Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks �ront Back: Right Side: Left Side:
DETAILED°DESCRIPTI,ON OF WORK:
CONSTRUrCT10'N INFORMATION:
.x.,. .,
Additionalwork,to be nertormed under this permit-check all appy:
HVAC Gas Tank []Gas Piping Shutters Q Windows/Doors
�Eleclric Plumbing Sprinklers Generator 11 Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Colnstruction:$ I c �� Utilities: Sewer Septic Building Height:
OWNER/LESSEE CONTRACTOR
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Name 4 Name:
Address:) ( Company: 4`
City: State: Address: l`�\
Zip Code-., Fax:
//�� City: au �St(ater
Phone Nb.�� ��"i2 Zip Code:��I�cI c;Faa "-t
E-Mail: I Phone N:) l �7-- L-t �- d �C,tx
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:— k ��Lp�3
If value f construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: I Address:
City: I City:
Zip: I Phone: Zip: Phone:
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I certify that no�ork 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
commencin ,work or recording our Notice of Commencement.
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_Sig a re of Owner Lessee/Agent Signa u o Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF I COUNTY OF
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The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 _by this day of ,20 by
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(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07%15/2014
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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