HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' / Permit Number:
RECEIVE®
Building Permit Application ,a
Planning and Development Services JUN f 2016
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
PROP.O:SED IMPROVEMENT LOCATION.
Address: `toS Iv U
Legal Description:
Property Tax ID#: �- 4`-V - bw - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED`DESCRIPTION Of WORK'
CONSTRUCTION INFORMATION
Additional wor toa Dertormed under this permit-check all appy:
HVAC 1:1 Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers 0 Generator 0 Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ C Utilities:Sewer 0 Septic Building Height:
OWNER ,LESSEEi CONTRACTOR:
� � .
Name t � Name:
Address: 1' Company: L✓
City: Stater Address: I Qvo io MAUO
Zip Code: L-�' Fax: /� City: State:
Phone No. Z -�17 IZ Zip Code: `J` Z Fax:��=
E-Mail: Phone Not- �- j7
Fill in fee simple Title Holder on next page(if different E-Mail: YY10 S W_0JQSLQ CA 0 - C6rYl
from the Owner listed above) State or County License: M?j� b I a43
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUF`PLEMENTAL.CONSTRUCTI.ON LIEN LAW INF.ORMATIO,N;
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 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.
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_Sign of Owner/Lessee/Agent b xl Sign to o ontractor/License o er
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STATE OF ORIDA STATE FLORID
COUNTY OF COUNTY OF :�'�'^
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(Signature of NotYy Public-State of Florida) (Signature of Vary Public-State of Floftida)
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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