HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater a� �r° Permit Number:
RECEJ\, :-p JUN.2 2616
Building Permit Application
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 Residentialy
"WITLICATION FOR: To Select from dropbox, click arrow at the end of line '1J�AQL, ppo f
Address: _�tin
- � 1� l `1�
Legal Description: taw& ,1 b 1)obir V I �I�l S L�)1A ,
Property Tax ID#: 35aa - &oq - oo i3 "- 000 !, Lot No.
Site Plan Name: aQ Block No.
Project Name: ow I ow 5'}]'O t-a
Setbacks Front Back: Right Side: Left Side:
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Additional work toe e orme under this permit—check a appy:
HVAC 11 Gas Tank DGas Piping _Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers 11 Generator Roof
Total Sq. Ft of Construction: pp S Ft. of First Floor:
Cost of Construction: 31 q6. 7� Utilities:]Sewer OSeptic Building Height:
0
Name iGzfi IQ, �I Name:
Address: I O �Uf'• 3 Com pann
City: TQn5M &a C1 State: E/_ Addr 10\
Zip Code:3 4 g 5 7 Fax: _ City: State:
Phone No. Caro S�D — qg a 5 Zip Code:
E-Mail: Phone No. /-1 $R� 1
Fill in fee simple Title Holder on next page (if different E-Mail: J U►
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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. LucieCounty 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
commencingwork o ur Notice of Commencement.
s
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLOR,1
COUNTY OF COUNTY OF
fo oing insacknowledg before me The for oing instru a was acknowlecla before me
TdayZof= 201 y thQSday of 20 by
(Name of person acknowledging) (Name of'person acknowledging)
ignature of Notary Pu li -State of Florida ) (Signature of Notary P lic-Sta a of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced 1
0 entification Produced
Commissi6tiTis on No.duIARM
My COMMISSION#
(Seal)
r EXPIRES:Decemb 3r 28 2016 .;. •,,, MELISA ARMENTO
ed Thru Notary pub is Underee"
MY COMMISSION R EE 655
a EXPIRES:December 28,201
Revised 07/15/2014 h, f;n` BondedTluuNotary Pub4cUnderwrit
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS