HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division r
2300 Virginia.Avenue,Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (7,72)462-1578 Commercial Residential V
PERMIT APPLICATION FOR:
W-90' RR(3VEMENT LOCATION it ,
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Address: l l,5 I Jc"_iZr70,5h1 CP Dr
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Legal Description: �� rQ,�m �1(X7A /�,�, 'J / e'2 1 '
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Property Tax ID#: /�c3 IFd,1` -.00 f�/a� ;! Lot.No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
QETAILEQ QESCRIPTION.OF WORK• " wI.
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CONSTRUCTION INFORMATION s
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Itiona wor to� a pe orme un.er this permit-c hec 'all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _&L'*Roof Pitch
Total Sq. Ft of Construction: /r6l V Sq. Ft.of First Floor: II
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
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OWNERfLESS,EE .CONTRACORiy
NameLee Name:
Address:115 D Company: "{
City: Ekt CP State: Address:
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Zip Code: 3VV6 Fax: City: State:
Phone Nc Jr6l 1 023&-6%!5'E Zip Code: Fax:
E-Mail: Phone No
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. !'
SUPPLEMENTAL CQNSTRUCTION LI:E lAW INFORIVIATI0 1. ,
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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 work or recording our Notice of Commencement.
4- ALM" A_,., .1,
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA p n I STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of ,20_ by this day of 20_ by
(Name f person acknowledging) (Name of person acknowledging)
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(Si atu of Notary Public-State of 60rida) \ (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identifications V Personally Known OR Produced Identification
Type of Identifi do �Te of Identification
Produced � ` _`_ Prgduced
LASHAHNA INGRAM
-( O^t�f Public-State of Flo Ida I!y
Commission No. �_+ :° �bmm Expires Dec 20,',OCImission No. (Seal)
cam: commission#FF 177249
REVIEWS FRONT Z N NG SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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