HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE -,COMPLETED FOR APPLICATION TO BE ACCEPTED--,,,,
Date: D I Permit Number. r bO "
_ Building -Permit Application•'' � -
Planning and,Deyelopment5ervices,
Building and Code Regulation Division
j2300 Virginia A_ venue, Fort Pierce FL 34982
Phone: (712) 4624553 ,Fax: (772) 4624 7$ Commercial R2SICI2ntial
PERMIT APPLICATION FOR: o�4,k, -
:.,
Legal Description:,
Property TaxIID"#- Lot No:
Site Plan Name:. _ ,,,,.Block No.,
Setbacks Front Back: Right Side:, -Left Side:
�
Additional work to be pertormed under this permit— check all t at app y:
Gas Tank .- Gas Piping _ Shutters _ s/Doors
_Mechanical _
I! _ Electric _ Plumbing _ Sprinklers _ Generator _ Roof ,Y'rPitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: ;
Cost of Construction: $y) '` '' Utilities: _Sewer _Septic Building Height: '-
Name; Y1, o
Name &gZ-1w, 0 C qa,
Address: O Q.
Company:. & 4 /r/yyt�e /c ito
City: State: _j'
Address: •3`0�2+-`� G
Zip Code: Fax:
City: State-AAi
Phone'No. %7P-- T?,�-67
Zip'Cod0:1" 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 Greta )5��
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name: f
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: '-.State:
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
commencingJvrnA or recording your Notice of Commencement. 4
Signatu
Lessee/Contractor as Agent for Owner
STATEIPF FLORIDA c`p
COIL OF
The forgoing instrumejpt was acknowledged before me
this ±t-- day of a k 20_[J by
(Name of person acknowle Bing )
ire of Notary P
Personally Known
Type of Identification
Produced
ic- State of
OR Produced Identification
CommissiorLsNd:' +''f't='•.bdAINGRA�vt-RAfr�l ) .
C,."J1f�iISSION f GG 275U60 S
EXPIRES: December70- 2022
Holder
STATJMF FLORIDA
COtMTY OF
The for oing instr eas acknowledged before me
this V day of n w201q by
(Name of(Jerson ackn ledging )
re of Notary PublitJ State of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced
Com mi$;4 9 t j�lp ^:.s, (Seal)
LASHAHtIN1N AM-RAHMING
`'� �, .•�aricclnN U GG 275060
Bonded Thru No
ary Public Undervmter
`
1UPERVIS
." EXP
RES: December20, 202
REVIEWS
F1 1
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I-AN5,ded
hVESGfiiTi�Td(Nr"r't
TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW ;'...
-9,E� `'
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. //ZU14