HomeMy WebLinkAboutBuilding Permit Application I j
All APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a - 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
hone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
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PERMIT APPLICATION FOR:
IyR \./ � l\ i�ME � A��l✓:�'.i..°-. '`.s'r 3�� - a 3',"a; z 2 �,° a.€ .�.„.ti.a"4`'�, _
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Address: ,�cl�i Dc me ��h �rtiry e
Legal Description: 7Hrpt-�n Eln c (ler
Property Tax ID#: �) Z 3 - �� -C' �.z� QQ0-G i Lot No.�
Site Plan Name: Block No.
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Project Name: .
Setbacks Front Back: Right Side: Left Side
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Additiona work to be pe orme under this permit-check all that apply: ; j
Mechanical —Gas Tank _Gas Piping _Shutters Windows/Doors
—Electric —Plumbing —Sprinklers —Generator Roof Pitch
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Total Sq. Ft of Construction: 10 L,', cr �`ee+ Sq. Ft. of First Floor:
Cost of Construction $ Utilities Sewer Septic , Building Height:
- +pRFy S.iyw W j i tq ^'A3Cs"N ri" r 'T.—s.'
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Name Oe-011-1 Name: Krl s Ver
Address: C(Oi , CJ C rhe Company:
City: r- Q;er c<� State:, Address: �GI' g„ �r- I ,�� )� 17n'�r
Zip Code: Fax: city: nc-<_ I State:
Phone No.2?2. - )7`1773 Zip Code: _444 k6 Fax:
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E-Mail: 0-po/i=4S �c-.�p, (4r�v�') .r��� Phone No 5g
Fill in fee simple Title Holder on next page(if different E-Mail Knt=P✓J C�Cc
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from the Owner listed above) State or County License.
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.!
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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 thepermit 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,l 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.
Signature of Owner/Lessee/Co r a Agent for Owner Signature of ontractor License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF - "
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this _day of 4C1D .201a by this6- day of 20_yg_ by
Name of person making statement. ' Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
APruced—__ Produced
( gna re of Notary Public-S to of Florida) (Signature of NotaryPublic-State of Florida)
Commission No. '
(Seal)_::_ = ILANS
mmission No. (Seal)
„n' LASHAHNAINGRAM .
,`,SPRY P" Public
-State of Florid
wwary �V
_, My COm .Expires Dec ^aq tp„,„�e Lt SHAHNA INGRAM
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REVIEWS FRONT S, i`NGCom i@wPERV&6R` VEGETATION . Teary rMANGRO'igorica
COUNT 'w•,, IEW4lndedthougl9EVI_8W�taryA VIEW REVIEW =,• 11yCom ER�VIEW2o,20 s
17
DATE `'���°� Bonded th ough P:atienal Notary As,n.
RECEIVED =-=
DATE
COMPLETED
ev.8/2/17