HomeMy WebLinkAboutBuilding Permit Application I '
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE CCEPTED M Date: (AE_ P rmit Number: u -050.-1
Building-Permit App ication
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
PERMIT APPLICATION FOR: To Select from dropbox, click rrow at the end of line
PROPOSED IMPROVEMENT LOCATIQN
Address:
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Legal Description:
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Property Tax I D#:} L4 OL-' QQ 2-9" o Lot No.
Site Plan Name: Block No.
Project Name-
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF,WORK
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CO'NSTRUCTIQN INFORMS, ION E
:Additional work toa er orme under this permit—c ec a a ply:
1]HVAC E]Gas Tank ❑Gas Piping _St utters ❑Windows/Doors
RElectr,ic ❑ Plumbing Sprinklers -G nerator Roof Roof pitch
Total Sq. Ft of Construction: S . of irst Floor:
Cost of Construction:$ a400.Od Utilities:'n Se er Septic Building Height:
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;OWNER/LESS;EE CONTR ACTOR:
!Name ('5 Name: 60e- l,-- W"WN
Address: Compan
City: Zr" Stat Address: ")!57 +Lo( +r
Zip Code: JLfi gg I Fax: City: c_c_e State: _N_
!Phone No.`12� � 2032&3 Zip Code- 3L `-l5 Fax:
E-Mail: Phone N:). 'n (3 33- (3 33(3 33
Fill in fee simple Title Holder on next page(if different E-Mail: CicxJ to o .NT--+
from the Owner listed above) State or ounty License: LPG�-1S��
If value of construction is$2500 or more,a RECORDED Notice of Commenc ment is required.
DESIGNER/ENGINEER: _Not Applicable MORTGA E 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 ermit.
St. Lucie County makes no representation that is granting a permit will authori a 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 eed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree th t I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St. Luci County Amendments.
The following building permit applications are exempt from undergoing a full c ncurrency review:room additions,
aiccessory structures,swimming pools,fences,walls,signs,screen rooms and a cessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commenc ment may result in your paying twice for
improvements to your property. A Notice of Commencement mu t be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, cons It with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signatu of Owner/Lessee/Contractor as Agent for Owner Signatur i f Contractor/License Holder
STATE OF FLORIDA STATE O FLORIDA
COUNTY OF �,L`I.�,��,A, COUNTY I
The forgoing instrument was acknowledge before me The fo0oi g instr ment was acknowledged before me
this day of 20M by this ay of 20-g by
�-I_ cv)r" oo
Name of person making statementame of person making statement
Personally Known OR Produced Identification N% Personally Known OR Produced Identification
Type of Identification Type of Id ntification
Produced Produced
of2��d�'L�
Notary Public-State f'Florida) (Signatur of Notar(Si re , r ic-State of orida )
Commission No, (Seal) r. Commissi n No,, � e% l
,, -A •; +Votary public
NA INGRAyi
o�Par nAaa,�� LASHAHNA INGRA
=0 4�? Nofar Public-S sn %F- 21 1o�cr�1y Comm Fye Stats of
-'& u•c MY omm.Expires Dec`0,201II " g n mmission • J ue 20 20
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DATE "-"
RECEIVED
DATE
COMPLETED
Rev.8/2/17