HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: F ermit Number:
2) 44=111
Building Permit Application
Planning and Development Services
i 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
PROPOSED IIVIPRQVEMENT`LOCATION3,
Mdress: MCCON V-6
;Legal Description:
i
Property Tax ID#: Lot No.
ISite Plan Name: Block No.
Project Name:
!Setbacks Front Back: Right Side: Left Side:
DETAILED DES:CRI,PTION OF WORK
CONSTRUCTION INFORMATION t
a
IAdditional work toe e orme under this permit-c ec a t
11HVAC Ei Gas Tank ❑Gas Piping _Shutters
I ❑Windows/Doors
1WElectric ❑ Plumbing Sprinklers ❑GE nerator Roof Roof pitch
?Total S . Ft of Construction:
q Sicl
of F rst Floor:
!Cost of Construction:$ __2�_ U� Utilities: Se er F]Septic Building Height:
,OWNER/LESSEE `tr CONTRACTOR
w� h
Name Name:
!Address: EEC Company ,
!City. 1 Stater Address: UJCQ,
Zip Code: (q4S Fax: City: St((at��e:
I
Phone No.M2 -7 o\ �(� Zip Code• ��t Fa __07 C 4
E-Mail: Phone N . _LZ-�-4LD
Fill in fee simple Title Holder on next page(if different E-Mail: Qc�, 0-CJ k WM
!from the Owner listed above) State or ounty License: U 3
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORIVIAT OWN bg
z
5 '
DESIGNER/ENGINEER: Not Applicable MORTGIGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEESIMPLE 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 author a the permit holder to build the subject structure
;which is in conflict with any applicable Home Owners Association rules,bylaw 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 th t I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St. Luci 2 County Amendments.
I1The following building permit applications are exempt from undergoing a full doncurrency review:room additions,
laccessory structures,swimming pools,fences,walls,signs,screen rooms and ccessory 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 mut be recorded and posted on the jobsite
'before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
icommencing work or recording our Notice of Commencement.
Sign fur of Owner es eMfiiractor as Agent for Owner Sign f Con ractor icense olde
� .
' STATE OF FLORIDA STATE LORID \
COUNTY OF moo., COUNTY OF wig.,
The,forgoing instrume was acknowledgeo4efore me The forgoi g instrum t was acknowledged before me
!
this-LO day of 20 by this ay of 20tt by .
I
Name of person making statement NarAe of person making statement
'Personally Known OR Produced Identification Personally Knb4 OR Produced Identification
TypeofIdentification Type of Id ntification
;.'Produced. . Produced
R
I
(Signature':f Notary Public-State of Florida ) (SignatUrlE, of Notary Public-State_of Eloridazj "
LASHAHNAINGRAM
Commission No. „����„ SeaIl Commissl �PRtyP', 't 11iit�NPUhIIC State da
s LAS�';n ll)ja INGRAM �La�e ���
Notary Public-State of Florida _.; ; •_My Comm.Expires Dec 20,X018
+ _ My Comm.Expires Dec 20,2018E =,Nr9" 'off? Commission#F`177249
pQ=C _ni.,, 1 RInPa t,ASS
OF F� n SJlull Irr I I I L9`J i RunpN u m^••^ _ ,_
REVIEWS R� II G SUPCR IS'bR PLANS �"'AWG tTATiON SEA TURTLE MANGROVE
I COUNTER REVIEW L. REVIEW" REVIEW REVIEW REVIEW REVIEW
DATE
1 _RECEIVED
DATE ,
COMPLETED
Rev.8/2/17
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