HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I 1-
Date: Permit Number: 401
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ECEIVED
Building Permit Application DEC 2 7 2016
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie Coun 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
EQ tl t M N :WCAI".
Address:
Legal Description:
Property Tax ID#: S'a l - Q 3��' 6 00- 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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_.,I-^(:r-�/ Z ZIP 1/4-e Com/
Additional wor to be t orme under this permit—check a appy:
0HVAC 11 Gas Tank ❑Gas Piping _Shutters a Windows/Doors
11 Electric E]Plumbing OSprinklers �Generator �Roof Roof pitch
Total Sq.Ft of Construction: q Sq Ft.of First Floor:
Cost of Construction:$ �a S� Utilities:LnJ Sewer E]Septic Building Height:
t � / FEE: CNTit>
Name , S C Name:
Address:q?0 c7 Y►'�Q�/Lo� G Company: �^J
City: /:;1`7 +01 f*—Ce State: R_ Addresjs:�q, 4A ft 6Q h
Zip Code: 13LM do Z Fax: City: 4 _I/W,
Phone No. Zip Code: Fax:
E-Mail: Phone No. ,?--
Fill in fee simple Title Holder on next page(if different E-Mail: i e
from the Owner listed above) State or County License: CSC
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Wf P`LEMENTAL CONSTRUCTION 1.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 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.
S
Signat re of Owner/Lessee/Contractor as Agent for Owner Signatuo of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF L4Cl G COUNTY OF 40-11
The forgoing instr ent was a knowledge4before me The forgo'ng instr ent was cknawledged before me
this' 2�day ofe�'eJY1f', 20 J�Gby this day of o !!wU 20 f�sby
A�n_ Ah�po &!It e
(Name of person acknowledging) (Name of person acknowledging)
Q
(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 Produ Type of Identification Produced
P
��<PAY PL� STELLA M. HUNTER mission No. ,;PR� J, �6lAf M.HUNTER
Commission No. .�r� '', FY P
+��.(S"9r Public-S
* _ y tate of Flo Coida +1�: NotaryPublic-State of Florida
Commission #FF 18055 Commission#FF 180552
rOFFsR' . xpues Jan 23,2019 ,`;t� —� ,' y amm.Expires Jan 23,2019
Bonded through National Notary Assn. bonded through National Notary Assn.
Revised 07/15/2014 �'� —
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