HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE 1 !PLETED FOR APPLICATION TO BE ACCE
Date: 1 ' O� ��� Permit Number:
y
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
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line I
Address:
Legal Description:
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
eA Q o v�' a � a s/�r,��L E; �n U�r D t�er� y n, �: ��e PL At.u^ ek t-4�.�,
Anr� LtS.
Additional work to e e orme un ert ispermit-c ec a apply:
�HVAC 0 Gas Tank ElGas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator)_S�f
Total Sq. Ft of Construction:
o�
Cost of Construction: $ o00
Sq.
of First Floor: _
Utilities: L_JSewer OSeptic
Building Height:
4 r
Name JaN c H u v,*) S
Name:
Address:'.,_ 0 56- GAAwep--
ST
Company:
/
City: S`; Z-0c;1 C r
State: 6✓L
s
Address: -
Zip Code: 3 H i 83 Fax:
City: State:
Phone No. 2_(6? - 61-5 -- 9/2 S
Zip Code: Fax:
E-Mail: <r6ALcqL1NAs :7 3 @ 61�-n4,
Phone No.
Fill in fee simple Title Holder on next page (if different
E-Mail:
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Name:
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:
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; vour Notice of Commencement.
Lessee
7E OF FLORIDA
NTY OF
The forgoing instrument was acknowledged before me
this j1 day of M(4 . 20 14 by
SigVE
re of Contractor/License Holder
ST OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this 17l . day of Nov : 20_1A by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- Statib of Florida')
Personally Known OR Produced identification
.yp of Ide fication Produced
r L .'41fj
Commission No DL®S_ (Seal)•ASHAHNAINGRAM
;ONOAISSION # EE 050558
e ••.PIRES: December 20, 2014
Revised 07/15/2014
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
T e of Identi ation Produced
`> y2S'- 4113.-
ommission No. Ei bsoSS� " `. (S INGRAM
' ION # EE 050558
A S: December 20,2014
i. Notary Puhlir. I Inrianurifarc
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