HomeMy WebLinkAboutBuilding Permit ApplicationSUPPLEMENTAL CONSTRUCTION LIEN LA1lV IN�t3RMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State: _
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: — Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the ksuance of a permit.
St. Lucie County makes no representation that is granting a permi' will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association ules, 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, 1 do her( by 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 ooms 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 Commence meat must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain finan..:ing, consult with lender or an attorney before
commencing work or recording vour Notice of Comme cement.
Signature of Owner/ Agent/ Lessee
Signature of Contractor/License Holder
STATE OF FLORID
COUNTY OF e _ (A-11 c - G
i he forgoing instrument was acknowledged before me rhe forgoing instr ment was acknowledged before me
this day of 20 14 by :his t� day of 1' l 20_]_4p by
Sri
{Name of person acknowledging) -- ii�ame of person acknowl.�gi )
Si nature of Nota Public -State of Florida (Signature, f Notary Public- State
{ g .. ry ) oorida )
Personally Known OR Produced Identification 'ersonaily Known OR Produced Identification
Type of Identification Produced 'Cype of Identification Produced it (n >.
Commission No. (Seal) :ommission No. (op!�_ � SE"LLEEN DEMERS
NOTARY PUBLIC
P -^STATE OF FLORIDA—
* Comm# FF065960
Revised 07/15/2014 Expires 10/24/2017
REVIEWS FRONT ZONING SUPERVISOR )LAMS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW F EVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLIC#kTION TO BE ACCEPTED
Date:
Permit Number:
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
Corni nercial Residenbal
PERMIT APPLICATION FOR: To Select from dro 3box, click arrow at the end of line
PROPOSED IMPROVEMENT LOCAT16W,
Address: 0 b 0 F_ (A)
Z.
Legal Description: bo�), s "A 9 0
�UT ov� a pi S T T T V\ kA kA N� VIIT 'TV\
Property Tax ID #: Lot No.
` U (u
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be D rtormed under this permit —chec
OHVAC Li
� all that apply:
Gas Tank Flas Piping
Shutters Windows/Doors
q
0 Electric ElPlumbing OSprinklers
Permit Number:
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
Corni nercial Residenbal
PERMIT APPLICATION FOR: To Select from dro 3box, click arrow at the end of line
PROPOSED IMPROVEMENT LOCAT16W,
Address: 0 b 0 F_ (A)
Z.
Legal Description: bo�), s "A 9 0
�UT ov� a pi S T T T V\ kA kA N� VIIT 'TV\
Property Tax ID #: Lot No.
` U (u
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be D rtormed under this permit —chec
OHVAC Li
� all that apply:
Gas Tank Flas Piping
Shutters Windows/Doors
0 Electric ElPlumbing OSprinklers
Generator Roof
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ utiliO
S:
0Sewer
OSeptic
Building Height:
OWNERAESSEE:
CONTRACTOR.
Name
Name: k -L) 0 iuiL
Address: 5 jz t'S�
City: State:`-
Address9-[31bSV0 q SSY—
Zip Code: �4 q Fax:
State
Phone No. \:I - ;au
Zip Code: Fax:
E-Maikoix"E"h"C' oloobv to�'\
Phone No. ��, L)kA
Fill in fee simple Title Holder on next page ( if different
E -Mail: Oct �o\ -0
from the Owner listed above)
State or County License: � l Ll
if value of construction is $2500 or more, a RECORDED Notice of, ommencement is required.