HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
i
Date: Permit Number:
i
_ Building Permit Application
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:
Address:
LI gal Description: 2-3 3 5 / � �F_- 0 r- S Z Or' 90 ! c5UJ L
Property Tax ID#: '1 3 - - _ -Z Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
® (r rp/ epC�NVI
Additional work to be pert irmed under t rs permit-check all that appy:
Zlec
hanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
+ tric Plumbing Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: 2- Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
Name �Jo im- iq-(As woge' Name: J9 67 16(J&
Address: *0 d WBS PW Company: --J0-`5- l_ co/uT FLACftuc
City: 1?� j ' State:IrLd+"y Address: Z-&?� LUCY W6'
Zip Code: Fax: City: - 0 IOC Stater-
Phone No. Zip Code: Fax:
E-Mail: Phone No ri z-- 32,-3 !S55
Fill in fee simple Title Holder on next page(if different E-Mail 4 t� d• COW
from the Owner listed above) State or County License �"�'7/®
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
i
i
I
FF
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 thepermitholder to build the subject structure
which Is in conflict with any applicable Home Owners Association rules,bylaws or an 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.
Pe 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 wor or recording our Notice of Commencemen
Signatur o Owner/Lessee/Contractor asr o
.Agent for Owner Signa f Contractor/License Holder
STAF FLORIDA STATE OF FLORIDA
COU OF S?�"> �, o COUNTY OF
The forgoing*instrument was acknowledged before me The fooing instr e t was acknowledge before me
this V day of ,20A by this in day of 20 by
(Name of person acknowledging) (Name of person acknowledging)
(Sign e o Notary Public-State of FI rida i toe of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
.r,
S HNA INGRAM �,,,,,,,,,� AS AHNA INGRAM
Commission No. tj �'d��G��., 4 ` S Commission No. aaY poo
o Nota y Uc state of Florida ,=m NotAty lic State of Florida
z a ' •=M Comm.Expires Dec 20,201B • My Comm.Expires Dec 20,201
`'a * y r 9 . Qr n#FF 177249
o �, Bonded th ugh National Notary Ass i.
F OF lhrou h National Notary Ass ." ,;of °p� �„
REVIEWS. FRONT, """" PER�`/l 0YJ1'I PLANS VEGETATIO GROVE
COUNTER REVIEW REVIEW . REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.