HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ermit Number:
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Building Permit Ap lication
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 arrow at the end of line
;.RR'OPO$ED.IMPROV MEIVT LOC'ATIO'N:'° ° V4
'Address:
Legal Description:
Property Tax ID#: 3`409- -10E)- COb Ccb— I Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
4
DETAILED DEC,RIPTION.OF`WORK
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CONSTR,UCTLO.N INFORMiATI,ON
AdditionalworK to e performed under this permit-check all ap y:
HVAC Gas Tank ❑Gas Piping _Sh utters Q Windows/Doors
Electric 0 Plumbing Sprinklers OGenerator F] Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ Utilities: Sew r[]Septic Building Height:
OWNER/LESSEE: ' .,CONTRACTOR;
Name a Name:
Address: SL� Company MOIA
tt,n�,n� L
Address:
'City: Stat2� (7 V'w\ Cx�
Zi Code:
Zip ���L-� Fax: rr City: K'eP/LQ Stater'
.Phone No. � - �3Z-�y �O Zip Code: L Z Fax,—D _L+ 01-`
E-Mail: Phone No - 2
;Fill in fee simple Title Holder on next page(if different E-Mail: G0AUD�f1^
from the Owner listed above) State or C unty License: ELI 56--) i U43
If value of construction is$2500 or more,a RECORDED Notice of Commence ent is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMAT ON_.�
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:l
City: State: City: I State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDINCOMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
TOWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtair 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 author i a 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 thz 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 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, cons It with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signatu wner Lessee Contractor as Agent for Owner Signa t a 'f Contractor/License Holder
I
STATE OF FLORIDA STATE OFJ FLORID
COUNTY OFCOUNTY
The forgoing instrument was acknowledged before me The forgoing instru ent was acknowledged before me
this J;j day of 20 -by this W d 3y of 267 by
�.drno�. .lAQ2
Name of person making statement N me of person making statement
Personally Known 1 OR Produced Identification Personally known OR Produced Identification
Type of Identification Type of Iden tification
Produced Produced
- I
isjAttlre of Notary PuWi-6 Stat of Flo.rida_) (Signatureof Notary Public-State of Florida)
%��%nRY noB, LASHAHNA INGRAM „111,,,,
=r* p r. No e L ommissio No. 11 ,:t�"Y°�'' LA;:(!S,e ���INGRAM
Commission No. �1 t _ S,41)blic-State of Florida
My Comm.Expires Dec 20,201f 3 ;` - Notary Public-State of Florida
'F ?c'' Commission#FF 177249 P My Comm.Expires Dec 20,2018
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y 1 wa"�u�a Notary Ass. 9 "� Bonded tt� �i 177249
REVIEWS FRONT ZONING -SUPERV OSI R PLANS VEGET Tf0 `311,— �` N "1S%IAINGRIOV
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW ARE If "
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17