HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
,
Date: k r-za— 9-0/ LP Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Legal Description:
RECEIVED
FEB. 0 B 2018
Building Permit Application permitting Department
St. (Lucie Co tv
V
Commercial Residential
Property Tax ID #: Lot No._
Site Plan Name: Block No. .
Project Name: _
Setbacks Front
Back: Right Side: Left Side:
nai worK to' oe pertormea unser tnis permit- c
_Mechanical _ Gas Tank —Gas Piping
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 7Utilitie
Name d.y& 6 it _Ayy
Address: CDU M wAk - !z%
City: /° L� State:lkil
Zip Code: Fax:
Phone No. `�-7?--
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed abive)
an tnat a
Shutters _ Windows/Doors
_ Generator L, -/Roof V/,Pitch
Sq. Ft. of First Floor:
s: _ Sewer _ Septic Building Height:
Name: A� i` /�
Company: d e A�4 _,zx �.
Address: S
City: State: -K
4,ip Code: 3 y=/y Fax:
Phone No i i ,�- —,)`Yo 0 7,o,-3
E-Mail�'A
��� 119 -01!
State or County License C- LAG
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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, 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 ecordin our Notice of Commencement.
of / Lessee/Contractor as Agent for Owner
SignaturekAor/License
Signature OR-Holder
STATE OFF ORIDA
STATE OF ORIDA
COUNTYO,�
COUNTY &•o ,
The forgoing instrume t was acknowledged before me
'$ 4�
The f%going instrument was acknowled ed before me
'D
this day of 20!2 by
this day of ftb 20r by
(Name of person cknowledg g)
(Name o rson ack wledging )
—(Signature of Notary Public- State of Florida)
(Sig ure of Notary Public- tate of Florida )
Personally Known ` OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
;,_
Commission No, (Sea I)--
Commission No. (Seal)
.NFLNFL, P!,6, LASHAHNA INGRAM
Notary Public - State of Florida
LA "'n,;�;! I
• . • E MyComm. xFires
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=? ��, notary ;;, - Sfale of Florida
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REVIEW
REVIEW �/I Wommis i°nR'E�VIEW4s
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DATE
Will 4P NutarY ASSn,
RECEIVED
-
DATE
COMPLETED
Rev. 7/ZU14