HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ) i
Date: Permit Number:
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Building Permit Application ,
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 C'
PERMIT APPLICATION FOR:
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Address: n 1,,,& 4,14
Legal Description:
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Property Tax ID#: V'Y�5 ' ® V!3®•�.mm0040 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be performea under this permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters +Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _L40of Pitch
Total Sq. Ft of Construction: 0&0 Sq. Ft. of First Floor: / />G
Cost of Construction: $ S UO Utilities: —Sewer _S eptic Building Height:
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01 �/LESS �t �� F � �h CONTRA OR ,r�� ��
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Name T` Name:
Address: Company: 12j& a
City: S L State:_ Address:
Zip Code: Fax: Citya..�• kleA_ /-p/k Stater
Phone No.� Kul — 6��'�I ZiplCode:�y ��, Fax:
E-Mail: Phone No 9 7, - U `�
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S��P'�LE[1tliEiVT�I.CtJNSTf�I'1CT'IC� LIEN (.®4W k1��QRIUIp►T�����iU. � � ���€�� :� ���„��
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
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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 wi h lender or an attorney before
commencing work, ordin our Notice of Commencement.
Signature of OL ssee/Contractor as Agent for Owner Sign o ractor/License Holder
STATE OF FLO DA STAT OF FLORIDV J
COUNTY OF COU TY OF
The f rgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of *ZV 20—n by this day of Mby 20[L by
(Name of person ackn wledging) (Name of person ackriawledging)
clam�w !S1,
(Signature of Notary Public-State f Florida) Jture of Notary Public-S to of Florida)
Personally Known . OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
LAShAHN ��; '�'�
�PqV pV y LASHAHNA INGRAM :°`P "el% A INGRAM
° °`��' Commission No. ?a ;mac No 9e81 State of Florida
Commission Na �? t a Notary Pu(S'eal):tate of Florida }
• r My Comm. Expires Dec 20,2018 's3g9 aQ MY 60mm.Expires Dec 20,•20-1a
Commission�FF 177249 �;;of FI.q;:`�� Commission #FF i 7724
Bonded through Nali nal Notary Assn, v through.lational Notary Assn,
REVIEWS FRO gig ONI _ R PLANS VEGETATION SEATURTLE -MANGROVE'
COUNTER REVIEW_ REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE -
COMPLETED
Rev. 7 4