HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED u
Date: �a`E I __ _ Permit Number:
RECEI'.'-D AUG 24 2016
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 Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
AddYeSs: n l � (�
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Property
Property Tax ID#: —614q '" Lot No_ _...
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left 5ide:
o? j 1 u� 1t
i lona r -o orrn@ un er permit—c ec a apply:
_HVAC 0 Gas Tank ❑Gas Piping _Shutters Windows/Doors
11 Electric M Plumbing 0 5prinklers ElGenerator Roof
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ Utilitles:]Sewer OSeptic Building Height:
Nam Name:'.��. �Q� —
Address; � Company: kit PrM 004q Jit F_ .I✓ �c
City State: Address: /0:11 A) Q�C'Q 'Pt_.
Zip Code: � 7 LQ ID— Fax: _ City: _ - Stater
Phone No. Zip Code:aDeLP Fax: c71
E-Mail.• Phone No. a�
Fill In fee simple Title Halder on next page(if different E-Mail: 0 k[-p# (. a.60/n
from the Owner listed above) State or County License: 01W Qe5f7gL05_._.____,.. ....
If value of construction is 0500 ar more,a RECOROID 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.Lucie Count makes no representation that is granting a ermit will authorize the permit holder to build the subject structure
which is in contiict with any applicable Home Owners Assoc ation rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Assoclation 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
commencN work or recording our Notice of Commencement.
s
_Signature r/lessee%Agent Signa a of s ractor/# cense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFCOUNTY OF
The for Ing Inst ment was acknowledged before me The for oing instrument was acknowledged before me
this�`r' day of 20 Mby this- day of 20 j___p by
(Name of person acknowledging) (Name of person acknowledging)
�.
(Signature of Notary Public-State oSignature of Notary Public-State of WrIda)
Personally Known Personally Known ✓ OR Produced Identification
Type of Identif Ica n dType of Identification
~ LTf£T{f ISMj,i
Notary Pu¢�c- tate of Florida GENA LOiltit RUK
Commission No. - "'` Commis'b1 I FF 957967 Commission No. Notary i16011d}Stale alFigrlda
�o My Comm,Expires Feb 7.2020• Ctimmtsttott' FF 957967
.h.
Revised 07/15/201.
REVIEWS FRONT i ZONING $UPERVI50R PLANS VEGETATION 5EATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS