HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� 3� 1\0 Permit Number:
RECE !EU
Building Permit Application OCT 3 12016
Planning and Development Services PER:01-1rT11G
Building and Code Regulation Division 5t. Lucie C unty, 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
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Address: d
Legal Description: � kc, r �4I K
Property Tax ID#: 1 U�� f� � �l 1 Lot No.
Site Plan Name: Block No.
Project Name:
10 Setbacks Front Back: Right-Side: Left Side:
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Additional worKtobe oertormed under t is permit-c. ec a appy:
nHVAC 0Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing OSprinklers 13 Generator 011oof
Total Sq.Ft of Construction: S .Ft.of First Floor:
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Cost of Construction:$ l OUB Utilities: _Sewer Septic Building Height:
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Name C ci 1Le. t Lf Name: _re:-f4 i/ it&VI-4,;
Address: 3 .�vk- d� _ -Company: c� V
-e State: _Address:
City: '— � - -
Zip Code: Fax: City: t ( C7 , State: R
Phone No. d Zip Code• 3 7 Fax: y6 oc-
E-Mail: lf� Phone No. �-�6 -5 3 6.1p -
Fill in fee simple Title Holder on next page(if different E-Mail: 1"LC, 0 !/teeC d
from the Owner listed above) State or Coun icense:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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 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
commen
=R work or recording our Notice of Commencemen
Signature of owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA � STATE-OF FLORIDA
COUNTY OF �l �1��I COUNTY OF U)CAE,
The f r oing instru ent as acknowledge before me The forgoing instrLmnit as acknowledged before me ,
thisday of 20 by this day of 20 /by
(Name of person acknowledging) (Name of person acknowledging.)
iA
(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 Produced Type of Identification Prod ed
Commission No. n (REN S. NIELSEN ommission No. � `'�•: "PeN'� S. NIELSEN
:` `�% Commission# FF 115637 .= Co mission k FF 115637
My Commission Expires ''y, o,r� Commission Ex it
as
June . 2018
Revised 07/15/2014
REVIEWS - FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS