HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �2 _ Permit Number: ` I
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Building Permit Application OCT 13 2016
Planning and Development Services PERi�iITTI
Building and Code Regulation Division
St. Lucie C nty, FL
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
PROPOSED IMPROVEMENT LOCATION _
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Address:+ 509 t�T
Legal Description:
Property Tax ID#: 2-H 0-7- 112 -' 00067- 000'- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
;.DETAILED DESCRIPTION OF WORK t
2 v _DUt t,W e Dvi le &o4e a,croSS '✓1� �-c
CONSTRUCTION INFORIVIATLON
Additionalwor toe nertormed unclerthis permit—check a appy:
❑HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
❑Electric ❑Plumbing []Sprinklers ❑Generator ❑Roof Roof pitch
Total Sq.Ft of Construction: SFt.
t of First Floor:
Cost of Construction:$ po Utilities. Sewer❑Septic Building Height:
OWNER/LESSEE CONTRACTOR:.:
Name Gl{ Q C__ Name: -i
Address:JJ 0 Td Company:
City: T .r State:�L— Address: f (-O Adi Si
Zip Code: 3 L19y-7 Fax: City: Stater
Phone No. Zip Code: Fax:;� �y / �-
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: r- (i!;& l
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 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 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
commencing work or recording our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/Lice se Holder
STATE OF FLORIDA ) STATE OF FLORIDA
COUNTYOF �(1,C r� COUNTY OF 4(cie
The fo tng instru nt as acknowledged efore me The forgoing instrument was acl owledged before me
thisday of �' 20 acknowledged
this_1L day of LX20 1(,-, by
\D4?_nrn\.e ks,.� �1) �� N
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known ,-'OR Produced Identification
Type of Identification P c _ Type of Identification Produced m
��,a��YP�.,, STELLA M.HUNTER `PQwP��.� STELLA M.HUN
Commission No. -•'�``� e`� NotJ*El}lic State of Florida Commission No. =2• ►`�; Notary(g6lflili-State
•; :• Commission#FF 180552 r•: Commission#FF
My Comm.Expires Jan 23 2019
'9, PDQ' My Comm.Expires Jan
Bonded through National Notary Assn.. Bonded through National r�
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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