HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE A CEPTED
Date: P 'rmit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)46271553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
P OPOSEO IN R01lEMENT LOCATIO
Address:
Legal Description:
I,
Property Tax ID#: --�v Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D T FLED DE=SCRIPTION Otis ORK:
CONSTRUTION I FQRMATION:
Additional work to be performed under this permit–check all that a ply:
Mechanical Gas Tank Gas Piping 7 Shutters - Windows/Do' rs "
Electric Plumbing —Sprinklers T Generator o o f itch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: =
_...
Cost of Construction:$ Utilities: —SeWer —Septic Building Height:
O N �R/L SSS E:
WON TRA MUM
R:
Name ��� /3r'/CC7 Name: `
Address: 75_0c� Sek� 1�2n kd Company:
City: ple/CX6_1 State:l-� Address:
Zip Code: ���95�� Fax: City: State:
Phone No. '7y– Zip Cod Fax:
E-Mail• �T� 06_; Cann Phone o
Fill in fee simple Title older on next page(if different E-Mail
from the Owner listed above) State o County License
If value of construction is 2500 or more,a RECORDED Notice of Commenc ment is required.
St1 LEMENTA CQNSTR+IJCTIQN.LIEN LAW IN `tJRMATIQN:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: of Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable . BONDING COMPANY: of 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 wgrk or recording our Notice of Commencement.
�o
ignki6re of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA �.�p STATE OF FLORIDA
COUNTY OF 5 11 a Lea 2 COUNTY OF
The 12.rgoing instrument was acknowledgeg before me The forgoing instrument was acknowledged before me
this day of 20_ by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
(SignaltuW o otary Public-State of Florida ) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificati Type of Identification
Produced t _ _ Produced
Qi �P6. LASHAHiNA INGRAM Co fission No. (Seal)
Commission No. =a+ * eaui'ar Public-
* y State of F rida
;N9• o; Y Comm.Expires Dec 20,2018
' '�•,��t,.•• r 177.49
Bond d thro ry
REVIEWS FRONT iStJRC)Ra� LA
AsNS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW IEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
!:Fe—v. 7/2014