HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I q
Date: -02 M Permit Number:
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: Ale- C'��,���
PRDENT LOGAT) e
Address: �? J JJ 4,pp",fe %
Legal Description:
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
/.��1� !O,(Gtei �fil���G,�•-/6�U�.1� G��i�� l��i���i� %�[�' �jC ��.� �ie�lrC��9��
/MMechanical Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing . _ Sprinklers _ Generator _ Roof . Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ y Lcz_9 e
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNER/LE-�S�S� �
CfONTR tT4 •
Name;
Address: �Fll %/1�.9% �/ % GJ/}G!
-e:: f�o.�/�GD G%GGeS �fL
Compariy:
,AilOre's`s: O�lv' � GAS Nei GeJ /
City: T l � Stater;(;'
City: /'�T ST°�, Le Lf.� . State: f�<i
Zip Coder Fax: c
Phone No.'774 32 Z2-5�/2O
Zip Code: Fax: �
E-Mail:
Phone No %%?�
E-Mail
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License SG e as�l3
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:.
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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 work or recording our Notice of Commencement.
;,: I I LA::
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Signature of Owner/ Lessee/Contra or as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA,
STATE OF FLORIDA
COUNTY OF �Vy_k
COUNTY OF
The forgoing inst ument was acknowledged before me
The forgoing instrument was acknowledged before me
thisQday of 20 �Qj by
his
to day of o 20 t$ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced �,._ Q
Producedplbw
(Signature of Notary Public- to of Florida)
(Signature of Notary Public- St a of Florida )
Commission No. S MyNG
60
Commission No. �Y".:Ye°'•. CAS HAHNAINGR(S"MING
' Lly COMMISSION # GG 276060
tRSHAN GG 2750
* .*_
StOR
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ondedThruNotary PubGc
ndenoters
REVIEWS
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PLANS
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OVE
COUNTER '
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EVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
qs
RECEIVED
DATE
COMPLETED
Rev. 8/2/17