HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l./ Permit Number: RECEIVED
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Building Per it Application SEP 2 3 2016
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 drop ox, click arrow at the end of line
PROPOSED`[M
.P LOCATION
Address:
Legal Descriptio
Property Tax ID#:` 103.U�l 0M.2) Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED
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Additional work toe e orme under this permit-c ec a apply:
❑HVAC 11 Gas Tank Gas Piping _Shutters ❑Windows/Doors
11 Electric ❑ Plumbing Sprinklers ❑Generator Roof Roof pitch
Total Sq. Ft of Constructio-n: L�� 0 S Ft.of First Floor:
Cost of Construction: $ -tem
om utilities: Sewer E]Septic Building Height:
OWNER
/,LESSEE
Name Name:LA
Address: Company
City: rf StatoL Ad
Zip Code: 2^1 Fax: City. Staca—
iA
33
Phone No. Zip Code- Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: kA-JulwM-0021111M Wt
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice o Commencement is required.
-WPPLENIENTALCONSTRUCTION LIEN °' UV-INF
.pp MORTGAGE COMP
DESIGNER/ENGINEER: _ Not Applicable ANY: 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 i suance 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 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,I 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 under oing a full concurrency review: room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to a on-residenti se
WARNING TO OWNER:Your failure to Record a Notice o Commencement m result in your payin ce for
improvements to your property. A Notice of Commenc ment must be r orded and po ed jobsite
before the first inspection. If you intend to obtain fina cing, consult lender or a tto efore
commencing work or recording our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner SignqWe of Cct i e
STATE OF FLO I P,A,,�, .,., STATE OF LOMm
COUNTY OF �1�R Y 1 COUNTYOFNA
The f oing ins ment was acknowledge before me Thegclayzipkw�
ing in ment was acknowledged before me
this�day o 20 LQby this20 1,�Pby
of person acknowled in ) (N of person ackno ledging)
(Signature of Notary Public-State of Florida) (Signature of Notary 7-OR
State of FloridaPersonally Known OR Pro uc I tification V Personally Known Produced Identification
Type of Identification-ProduceD Type of Identification Produced
ANDI (1�WCHISOP�
Commission No. � Commission No. �, ®I MURCHIS
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Revised 07/1 007139"153 FIwideNoteryServic®com
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DATE
COMPLETE
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