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HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n� 7 Date: Permit Number: t71. haling rermill Appillicavon 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 _ PhKMI I APPLICA I ION FUR: To Select from dropbox, click arrow at the end of line PROPOSED IMPRUVEMENI LUCAIION: Address: %© C 7 J Legal Description: Property Tax ID#: Lot No. Site Plan Name: Block No, Project Name: Setbacks Front Back: Right Side: Left Side: DEIAILED UESCRIP110N OF WORK: CONSTRUCTION INFORMATION: Additional worko e erorme under this permit—check a a appy: HVAC Gas Tank ❑Gas Piping _Shutters ❑.Windows/Doors Electric 0 Plumbing Sprinklers 1:1 Generator Roof Roof pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ Utilities: []Sewer Septic Building Height: OWNER/LESSEE: CONTRACTOR:, Name Name: Address:/V(0 Company. C r City: dc_ Lf State: Address: / q S S- Zip Code: Fax: City: CW-_ State:.-L Phone No. �` /��SS3 C qG/ Zip ode:� / � "-r`3 Fax: E-Mail: Phone No. -)"?d - Fill 7d -Fill In fee simple Title Holder on next page( If different E-Mail:Coi-,L;:,C-2 n����„"L .c a from the Owner listed above) State or County License: C j\C_ Itf /.Ty? q If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. _SUPPLEMEN I AL.CONS 1 RUC I ION LIEN LAW INFOIZMA I ION: E 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 i tend to obtain financing, consult with lender or an attorney before commen ' work or recording y Notice of Commencement. s 4 igna of Owner/Lessee/Contractor as Agent for Owner J igna racto License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COUNTY OF "sA �xpy The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this_IL6.day of , 20Ll_by this day of f /t61 ,20 by (Name of person acknowledging) (Name of person acknowledging) AJ (Sid—naturd of Notary Public-State of FI ida) (Signature of Notary Public-State of 4rida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of I entifi tion Produced ,Type of Identification Produced Commission No. .......Seal),,:. i sion No. LASHAHNA INGR M LASHAHNA INGRAM .,��ra r�B�''. 0}Florida • My Comm.Expires Dec 20,2018 '.:° • My Comm.Expires Dec 20,2018 , Revised 07/15/2014 =;91 p�:� Commission#FF 177249 °o;; Commission#FF 177249 °� ����• Bonded through National Notar Assn '%eP�F�° Bonded through National Notary ass REVIEWS FRONT ZONING SUPERVISOR PLANS . VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS