HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q{�
Date: Permit Number:
C4W MII:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)4624553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
1�r
P OSED 101/ (1/1° LC�CATICI«11.:
n
Address: 5 2 ' �� J ► -
Legal Description:
i
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:-
Setbacks
ame:Setbacks Front Back: Right Side: Left Side:
d � A °ED D�E�C • PTtOI�I � _ 1NORs `
fep
116
I
uTraR� Tro : OilPi'
Additional work to be pertormed unclerthiSperm-it-CheCkalithatapp y:
_Mechanical m _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: $ 4,16T Utilities: —S wer _Septic Building Height:
;Name 1KAf U7-7-J Name: 177At
Address: 71�d 2 �aw,�� S�
Company: tI/AlIc-ad 16 P 'e'4/ti
,CitState: FAddres :
Zip Code: 1?4ry Fax: City: Ge State:
Phone No. 7� Zip Co e: �� ��/ Fax:
.E-Mail: Phone o
Fill in fee simple Title Holder on next page(if different E-Mail / ee @-- e-c4(/OfCO
from the Owner listed above) State or County License C4-r- AT 1/F 3 3 S
If value of construction is 2500 or more,a RECORDED Notice of Commenc ment is required.
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 OWNE :Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to yoL)F propTyou
rty. A Notice of Commencement must be recorded an posted on the jobsite
before the first insVItio
. intend.to obtain financing, consult with lendero an att rney before
commencin work orn our Notice of Commencement.
Sign ture of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/Licen Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF 1%4
ThereTclay
ing instr ent was ac knowledgbefore me The forgoing inst ument was acknowledged before me
this of 20 by this day of 20J& by
(Name of person ac wledging) (Name of person ackno edging)
J( ture of Notary Public-Sta of Florida) (Signature of Notary Public- ate of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced :� _�. _ -
,11 �, LASHAHN71NGRAM ,
Commission No. `�` s. �(Seal)--�"'- Commission No' :�_�, ��. No4ary Public-LASHAHNA INGRAM My Comm.ExpirCommission
a r� +r Public Slate of Florida ,,9* `
Comm C p resDec`�. onded throng;National N Mary Assn.
•=My ��r,;n
REVIEWS FR ,* ae,�0iHNC51�ssio SUPERVISOR! PLANS VE 'ET%�Tf0f5� �SEATIIRTLE IVIAh1G OVE
CO , RFBV 9Wro gt'!''`''OREUhEUV r� REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.