HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date:_— Permit Number:
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 , Residential
PERMIT APPLICATION FOR:
Address: Il~ �U s Cy'� "Re--e-Q, rV 3 9
Legal Description:
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Property Tax ID#: d 0 0 - 9 , Lot No. �
Site Plan Name: ---- i Block No. 2 S�
Project Name:___ ( �.► y
Setbacks Front Back: Right Side: Left Side
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—Zle 44
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Additional work to e,performed under this permit--check all that appy:
_~ Mechanical _Gas Tank. _Gas Piping ^Shutters Windows/Doors
_Electric _Plumbing _Sprinklers Generator I hoof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cast-of Construction:$ 4 ' Utilities: Sewer _Septic Building Height:
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Name
;Address:_ UQP.tiI Company ! ' ` �_ '��d�AY
'City: _Pj;Ar6t State: Address: 92109' _
Zip Code: Fax: City: l/,e✓r? <G�, State: F2
Phone No. �4 -1 G J 7 Zip Code: 3 , 6 ) ' Fax: ✓
E-Mail: Phone No ��� � —'.,fit �'/j� �"�21
Fill in fee simple Title Holder on next page(if different E-Mail G.d � i�-t i✓- � ,1+ ` �'Q
from the Owner listed above) State or County license Ii�l ud e
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if value of construction is 2S00 or more,a RECORDED Notice of Commencement is required.;, i
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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:
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 w or recording our Notice of Commencement.
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Signature of Owner -Lessee/contractor as Agent for owner' Signature o ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF . COUNTY OF:
The forgoing instrLpent was acknowledged before me The for oing instrurAprit was acknowledged before me
thisB�S day of 20 "1 by thi day of 20_1] by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-52ate of Florida) \ (Signature of Notary Public-St of Florida)
Personally.Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificat'on T pe of Identification
Produced �1� _ _�_- � oduced �L -
LASHAHNA,ING�AC4 LP, I! 11 ..i
t ,kPR ; Public-State of Floris a J! Rya S} 4HNA ?i
Commission No. 1I :��'���, (5e�1) ;res Dec 20,2C 1 Commission No. ``I :`.�`/ �% Notary Pul($eallate o. floriC,a
.:My Comm.Exp
Commission# FF 177249 # a My Comm.Expires Dec 20,2018!,
—i nit Asn. "� :. a;; Commission#E FF 177249
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REVIEWS FRONT >z-BONING SUPERVISOR PLANS VEGETATION%�:;;SEA-TURTLE AWA VE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE ,
COMPLETED
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