HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO B ACCEPTED q l t
Date: Permit Number:
�
Building Permit Ap lication
Planning and Development Services
Building and Code Regulation Division t ,
2300 Virginia Avenue,Fort Pierce FL 34982 y
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential 1/\
PERMIT APPLICATION FOR: To Select from dropbox, clic arrow at the end of line
PRµOPOSED IIVhPROV'EMENT;LOCATIONa
;Address:
35
Legal Description: _. . ..
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
LED,,-DESCRIPTION OF WORK
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6�c�-est. ?�� w` .� bv�
{�CiRISTRUCTION INFORMATION
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Additional work to be nerf under this permit-c ecl-a _❑ pp"y: Windows/Doors
❑HVAC Gas Tank ❑Gas Piping hutters
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Electric ❑ Plumbing Sprinklers 11 Generator E] Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
j Cost of Construction:$ 3cx�` Utilities: _Se er[:]Septic Building Height:
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OWNER/LEACTOR
Name _ Name:
Addres �-( S Q `(� Compa y: ��
City: State:- AddressVo. --n2
l� 1/ v� (,l)C
Zip Code: Fax: City: Stater
Phone No. - - 32 Zip C (0Z Fak.l l(_ 4LQ`
E-Mail: Phon , 14u\- _3z
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: �31�b �LQ.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLE`MENTALC0NSTRUCTI'ON LIEN LAW INFORMA IO,N
DESIGNER/ENGINEER: _Not Applicable MORTGbGE COMPANY: _Not Applicable
'Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDIN G COMPANY: Not Applicable
Name:. Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtz in a permit to do the work and installation as indicated.
I certify that' o 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 thepermit 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 yotir 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. Lu ie 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 m ist 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 work or recording our Notice of Commencement.
Sign &7 OLIN seac 6b r as Agent for Owner Signa r f ContractorA:iFen`s`VIolder
STATE OF FLORIDA STATE F LORID
COUNTY OF COUN OF a�
The forgoing instru ent was acknowledgAebefore me The faT ing instru ent was acknowledg before me
1 this�day of 20� by this ` day of 1. LA 201A by
i
I ,
j Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification V
I Type of Identification Type of Identification
j Produced Produce
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( ' t e of Notary Public-State o*f Florida) (Signatu f Notary Public-State of horicla)
Commission No. (Seal)-
Commission No. y, iNA INGRAM l9
LASHAHNAINGRA yPubl')
°•�%� ��•� Notary Public-State of Florida
Notary Public-State of Florid ? * My Comm.Expires Dec 20,2018
= 'AM Dec 20, mission#FF 177249
FF 1772
nF F F`�'� Bonded throw h National Notary Assn.
s• o"� Commissi n # . �` y
REVIEWS FR I� ;F0 ,'20NNfihrougt NSUREIRVIS PLANS VEGETATI "MAN R6`
COU' rp
/ � REVIE1/ REVIEW REVIEW REVIEW REVIEW
DATE -
' RECEIVED
DATE
COMPLETED L L
Rev.8/2/17