HomeMy WebLinkAboutBuilding Permit Application t 4
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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��j.�1%5 - Building Permit Application 'MMSM21 %
Planning and Development Services hf,, rr"t
Divisiont�rerrrn�►5� � v
Building and Code Regulation StStC,lal� &A4l�t
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential _
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVLMEAT LOCATION
Address: (J m eap 07 9- L/
Legal Description: 1ZV_f 6ZrP- eXI-b— 0-6- 911 6216eL y9 fyxl:?)� h1pe
Property Tax ID#: 4,bre//J Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front_ Back: Right Side:_�Left Side:
OETAILEO DESCRIPTION .0 WORK
GUNSTRUCTION l[V: A: :
F
ORM .. TION
Additional workkto be nerformedunder tis permit-check all appy:
HVAC L_I Gas Tank ®Gas Piping _Shutters []Windows/Doors
11 Electric ❑_Plumbing Sprinklers Generator ®Roof Roof pitch
Total Sq. Ft of Construction: SQ. Ft.of First Floor:
Cost of Construction$�2-�d G 00 Utilities:D_Sewer a Septic Building Height:
01NNER�LESSEE - CONTRACTOR :. '; ::�:`.`
Name Name:Ment R k L- e1, 1 L C 1
Address: `0&16 e (,TA.01,A_j2C ID 1 G Company: a' ! I,
City:ST��'1.5°�? /-� State Address: lS to I'plc u P,c_ r1
Zip Code: L Fax: City:�� f\ A l_�j Stater,
Phone No.'Tn R-37 / ° Zip Code:39 9 9 5 _1 Fax:-FID D D"'tea- 1 �l
E-Mail: Phone No._1 `( 3L �D I -14 r% 1 S
Fill in fee simple Title Holder on next page(if different E-Mail: l i I C-) I O_ �:`! 1 C_ 0 I
from the Owner listed above) State or County License: i (D!2� _�
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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 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
ommer)c)ng Work or recording your Notice of Commencement.
/,;na.tu e A�of Own6r///Lessee/Cont F4c_tor as Agent for Owner fSignature of tractor/License-Rolder
STATE OF FLORID ft STATE OF FLORIDA
I Sk-
COUNTYC . COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrume
q.nt was acknowledged before me
this Bn day of 20fl by this 10 day of 20A by
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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
Produced Produced
(Sig i4.t�ie okot—ary Public-State of lorida) (Signature of Notary Public-StaA of Florida
Commission No.
Commission No. Seal)
..8"" LASNAHNA INGRAM
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Notary Public-State of Flor d;
Notary Public mv Comm.E'012s Dec 20. 011
State of Florida
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xpires Dec 20,2011
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COU T Assn rREVIEW REVIEW -REVIEW_ -REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17