HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE,INFO MUST BE COMPLETED FOR APPLICATION TO BE A CEPTED I Q�
Date: P rmit Number: { (gyp •�7�'1
Building Permi 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- Comm2CC181 R2SIdeCltlal
PERMIT APPLICATION FOR:
PROPOSED IN;Pc�OUEMfENT LOCATION:
Address: / 0
Legal Description:
Property Tax ID#: 13U ` 6.0A C)IOD( Lot No.
Site Plan.Name: Block No.
Project Name:
Setbacks Front- Back: Right Side: Left Side:
DE AILED DESCRIPTION QF WORK:
e 0. �r SYS ^I
CONSTRUCTiQN IN'FOR'MAT{ON:
a workto a per orme under this permit—check a that apply:
Zpchanical
-'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: $ �a Utilities: _Se er _Septic Building Height:
OW E /LE�S�SEE• CONT A OR:
Name A/! e or 0,,7 Name: 1^44
Address: ' 76ze) c� /09d,- Jr, Compa y: u( ee f' car as
City: / f"��I—G if Stater Addres : 0.0 ('4111ceil 2
Zip Code: Fax: City: /�eo"C State/`C
Phone No. 77 2 3 S'� �6 Y(r Zip Co e: Fax:
E-Mail: Phone. 0 7 97l S 8
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State o County License (24 0 33
If value of construction is 2500 or more,a RECORDED Notice of Commenc ment is required.
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!'��N LAW(N!FORMATI,•`N:
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 insp(*tion. If you intend to obtain financing, consult with len-er or an attorney before
commencing work c(.f recg4ng your Notice of Commencement.
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w
ignatu a of Owner/ ess Contractor as Agent for Owner Signature of Contractor nse Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF COUNTY OFA
The forgoing instrument.was acknowledged before me The forgoing ins rument was acknowledged before me
thisi'a day of 20n_ by thiaa day 2V-,— by
n asL NA
(Name of person ackn ledging (Name of person ack wledging)
'- ignaiiture of Notary Public-St to of Florida) ign u of Notary Public-Sti;4 of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced ` + „ Produced
LASHAHNAINGRAM
LASHAHNA INGRAM
„o: Notary Public-State of Florida aY,�e hn
Commission No. �• " ° Commission No. ;`;�� �. Notary:S� State of Florida
Prly l(Saal)Expires Dec 20,2018 7 u=.,__My Comm.axires Dec 20,2018
` "o: Commission# FF 177249 =°
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r: pt F� �' =�,° "oma; Commission#FF 177249
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