HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
� 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 l/
PERMIT APPLICATION FOR:
PR:CPOSFD IN,RRCUEMEVT L�CATICN•
Address: '/-A9'—' )
Legal Description:
i t
i I
Property Tax ID#: (t 7o?5.-PlOrl. EJca(0,CC03 I Lot No.
Site Plan Name: I Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side.
DTAlLED pESCRIPTtON OF WORK:Y, k _ Te
m
�s_x
G1M'ii
OxNTRUCTIQN INFOR�VIATIC)NA.
,
itional work tc a per orme un er this permit—check all that appy:
_Mechanical _Gas Tank —Gas Piping _Shutters ° Windows/Doors.
Electric V Plumbing _Sprinklers _Generator _Roof Pitch
TI tal Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ � �' �0 Utilities: —Sewer _Septic Building Height:
OWNERfLESSEE: COIVTRACTOi
Name �'�Gy �?i> 1�'1•L�� Name:
Address: �`Xo L 2✓ ��-- Company':.i
� ,•; ;r,; :�
i ,r
fCity: l�e�i S�- �Gi F State:�_� Address:
Zip Code: 31 195--?— Fax: City: I i t State:
7Zip Code:No. ( � lFax:
E-Mail: rtAf�IJ Y M aJ4542 4A11)/L Gf DSI 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 reiquired:,
i
SUPPLE11/IENTAI.CONSTRUCTION LIEN tAW IN.. F�RMATIC}N .
�HCOMPANY:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE CO MPANY: _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 1
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 recordiUMur Notice of Commencement.
Signature of Owner/Lessee/C tractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Sc,,,e , COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of-RSD 2d�L_ by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signa ure of Notary Public-Sta f Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced ffi _ Produced
LASHAHNA INGRAM
Commission No, ;�,R.P`e,,,,
tintary Pub(Seal)ate of Florida Commission No. (Seal)
_'•: :• My Comm.Expires Dec 20,2018
i r 7774
%°����'•• onded through Natioi al Notary Assn. -
REVIEWS t. _ �11�IC -SUR OR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014