HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1�_o Permit Number:
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Building Permit Application SEP I k 2016
Planning and Development Services
Building and Code Regulation Division Lucie T unty,
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie Ccunty, FL
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 1 P .woo k Cc .
Legal Description: 5a. janne. Club —haA *wo — 601- 19 Lo+ 22
Property Tax ID#: 3q a 5 --�o a-01 q 5 - o 0 o-9 Lot No.�
Site Plan Name: 11 Block No.
Project Name: i:A&d& wood
Setbacks Front Back: Right Side: Left Side:
DETAfLED DESCRIPTION OF,WORK
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CONSTRUCTION:INFORMATION:
Additional work to be Dertormed under this permit—check all appy:
❑HVAC —Gas Tank ❑Gas Pipingi
n
g
Shutters
❑Windows
D o
s
1-1 Electric Plumbing ❑Sprinklers _Generator
2 Roof
Total Sq. Ft of Construction: b 11 S . Ft.of First Floor: lo-Q21-
Cost of Construction:$ rA CSU . 6'0 Utilities:
SURPLEMENTAL'CONSTRUCTION L{EN,;.LAW INFORMATION
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 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
commencing work or recording our Notice of Commencement.
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sigr6fure 4 Ow /Lessee/Agent Sign of C n act / cense Holder
STATE OF FLORIDA I STATE OF FLORI I
COUNTY OF 5�- . L V G COUNTY OF S* . L v C
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of $ e0 20 Eby thisday of ig-o D ,20 _L4_by
(Name of persona owledging) (Name of person acknowledging)
(Signatur of o Public-State of Florida) (Signat Notary Public-State of Flo\i���I1i111
Personally Known _OR Produce��!{d nation Personally Known OR Pro( Fgw4
Type of Identification Produced ���� ,k iii Type of Identification Produced�� � ,e •$o,
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DATE
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INITIALS