HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number: ®Cp • 10 (, Vs -
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 ' I
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial 11 R sidential
PERMIT APPLICATION FOR:
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CAP'R�®POSED INPR01/EMENT L®CATION:
Legal Description:
Pr�bperty Tax ID #:�C c�O. 2ca o % S e Dfl0 �o
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Site Plan Name:
Project Name:
Setbacks Front Back: Right Side:Left,' Side:
3
Lot No.
Block No.
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Aaaitionai worK to oe perrormea unser tnis permit— cnecK au mat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors.
Electric _ Plumbing _ Sprinklers _ Generator ! _ Roof Pitch'
Total Sq. Ft of Construction: Sq. Ft. of First'Floor.
Cosof�Corstruction�$� U Utilities: Sewer Septic Building Height:
�Y,..
QWN�ER/LE�SSE�E:
CONTRAC�+T®R:
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(Name st r` c
ess:S4—
�' (— ! ' ; P r� State: (.
Code: �`7 Fax:
[PhoneNo. % �� I .Zip
Name:
Company:
Address:
City: I
Code:
Phone No 1
E -Mail
Statex0o unty
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State:
Fax:
ail: -
,me --simple Title Holder on next page ( if different
from the Owner listed above)
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License!
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-
If value of construction is 2500 or more, a RECORDED Notice of Commencement) is required.)
DESIGNER/ENGINEER: _ Not Appli
Name:
Address:
City: State,
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
e MORTGAGE COMPANY:
_ Name:
_ Address:
City:
Zip: Phone:.
Not Applicable I BONDING COMPANY:
Name:_
Address:
City:
Zip:
Phone:
Not Applicable
State:
Not Applicable
OWNER CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 your Notice of -Commencement.
Rev.
En 6.e:o'FOwner; lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
10i3
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF !�' 1
COUNTY OF
The foraoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
thi day of 20� by
this day of 20_ by
(Name o Iperson acknowledgin )
(Name of person acknowledging)
(Signature of Notary Public tate of Florida)
(Signature of Notary Public- State of Florida )
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Personally Known OR Produced den ificatio T
Personally Known OR Produced Identification
Type of Identification ` —= LASHAHNA INGaAff--
Type of Identification
P oduced . s��e<;�•, ar Public -State of Florida
iL Dec S
produced
tD co, S' . Expires
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'sw Q # FF 177249
Commission No. o;.. . cq(961yion
National Notary Assh.
C mission No. (Seal)
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