HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date: Permit Number:
-- _ Building Permit Application
Planning and Development Services
e'uilding and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PR,fJPiJSED ! • RQUE 4ENT LOCATIbN:
Address: .<.30S 0Ak9 �15_f fa,`�'c�
Legal Description:
Property Tax ID#: 0C/ ) )o n d D 4) 6)'D S Z Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE AILED D:SSC IPTIQN/OF WQRK• [�
!Ase. 1�. {i 11 -! J►• S
50
-ICL )1 9(0'-( 1s
CQ ST +U.0 IGIN; INFIORMATION:
Additional work to bepe orme" under tis.permit-c ec a tat appy:
_Mechanical _Gas Tank _Gas Pipinghutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ ) Utilities: —Sewer —Septic . Building Height:
Name 3 0A . LS ) Name: G- �. •c -
Address: ��o.i S 44e(u (24,U Company:_- P"OJoe,-!'
City: State::M Address ,�,S -s SL. �..
Zip Code: `I q I. Fax: City: 0014 L State.A:�4
Phone No. Zip Code: ` 96 Z-- Fax:
E-Mail: Phone No -7 7 2- g3- 62-00
Fill in fee simple Title Holder on next page(if different E-Mail G Ale 43,,Ce- -t e- 02 6L&I'L."
from the Owner listed above) State or County License �i (3G %Z 5')Q3 d
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU1111@ NTA CONST UCTIaN LIEN LAW fNFORMATION:
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.
siffgR�Feof Ow see r ar ac.Agpapt for Owner o Ftontractor ens
STATE OF FLOR!IDA D STATE OF FLOR A
COUNTY OF -mac UN&.i�e�.g COUNTY OF ,o9,_,
The forgoing instru ent was acknowledged before me The for oing inst ument was acknowledge before me
this day of 20�by this day of 20AL by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification �1
Type of Identification Type of Identification
Produced Produced
L �A Ko
Qaffir�—of _�Notary Public- ate, Florida_)=��'�-=- - :9Signatu f otary Public-State o lorida)
f A,,, LASHAHNAINGRAM, I,
oue%; ^�} ry Public-State of Flo ,:
Commission No. ._ tr ,(Sea1 Commission No. /Seal
ff p•:ivly Camm.Expires Dec 26, 'G�:, ��� „� ----
Commission#FF 17729 3 oo0A "Lm1LASHAHNA INGRANI
NUfary Pnhii,-c#.,
- ..
N My Comm.Expires )ec.,21 'sir
REVIEWS FRONT S OISOR PLANS VEGE A } Boa°'SEA�T,t�R;tiLE; IFMAAVGR�OVE
COUNTER REVIEW REVIEW REVIEW REV B1Ri4�'VIELW,hNation!INofi�k&,\
DATE
RECEIVED
DATE
COMPLETED
ev. 8/2/17