HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED p �j
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982-
P;hone: (772)462-1553 Fax: (772)462-1578 Commercial ,fir Residential
I `
PERMIT APPLICATION FOR:
Address: 0 9 f G ke_'
Legal Description:
)
Property Tax ID#: I q a S(00'5 -0 000 _C000 Lot No.
Site Plan Name: Block No.
Project Name:,
S1 tbacks Front Back: Right Side: Left Side:
I . .
Mona work to be peOrme un er this permit-Whec all that appy:
_Mechanical —Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction:. Sq. Ft.of First Floor:
Cost of Construction:$ vZ Utilities: —Sewer .—Septic Building Height:
Name l l i /Ul,t f rt Name:A Z ze,i;s,, A04,
Address: g3S ° ad' ti (''�a� - Company:/4- .4n-,s �e•�c� a2 LLC
City: I J-e� State:- Address: s�-
Zip Code: 3a l ( 0 Fax: 9?;L-X971 -2031 City: Vcr6 lbr--14 State:
Phone No.?� .a -�`��- ' Zip Code: 3P-1 6 Z Fax: 997 "995-2031
E-Mail:a �j e ae=, Vadiao, fee" Phone No 12
Fill in fee simple Title Holder on next page(if different E-Mail �S r=ice aG/aAov,C��
from the Owner listed above) State or County License
Af 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 work or recording our Notice of Commencement.
Signa F e of Owner/Lessee/Contractor as Agent for Owner Signature 6fecntractor/Licerise Holder
STATE OF FLORIDA \ STATE OF FLORIDA `
COUNTY OF, `hag g , COUNTYOF a
The forgoing instr ent was acknowledged before me The forgoing ins ment was acknowledged before me
thi Flo day of� 20 . by this�LQ day.of 2(Kb by
(Name of persona nowledging) (Name of person knowledging)
1
i ature of Notary Publict State of Florida) n ture of Notary Public-St. a of Florida)
Personally Known OR Produced Identification Personally Kno ,<Producedldentificatip.
" "'�� LASHAHNA INGRAM
Type of Identificatio ,. 7FIo�rida
Type of Identi a�� o �,
Produced „����,,, LASHAHNA IN,GRAProduced '�* es Notary Public--State of Florida-
20; Notary Public.-State of ;�* *� mm.Upires Dec 20,2018
Commission No: _•: :•?filly Com(>5e�1)ires Dec,2 , r, '�e o-°.'. Commission;#� .1,�2y9 f;=
Commission N' oFF�� 1201
Commission #FF 177249 11110ugh National Notary3;; `
Bonded through National Notary Assn ?
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