HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLEl'eu'rOR APPLICATION TO BE ACCEPTED
Date: Permit Number: (,YF�/� oaaaa._
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Building Permit Application A MgRO�
Planning and Development Services err�ft ?Q?Q
Building and Code Regulation Division 4r 4i �V DI
2300 Virginia Avenue, Fort Pierce FL 34982 e CCU en,
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial _ Residential tk
PERMITTYPE:
PR POSED IMFRQ, TOCAT d
Address: 1 a &
Property Tax ID #:
Site Plan Name: _
Project Name:
Block No.
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: a a'-) O
Cost of Construction: $
400
Sq. Ft. of First Floor:
Utilities: —Sewer -Peptic Building Height:
Name PAJf Z A Ntee-
Address: 2 9S,;A S IE Fart ley iecj
City: iPe a+ St, L v c i e State:
Zip Code: 3 11957�2 Fax:
Phone No. 772 - 370 - Cj-241
E-Mail: .orii) 61 .eer'fS* Juri'r— Ccr»
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: 8 tz r amf M e f f-wv
Company: CO i'a► I 1 o d e-9S
Address: 7,J [9 9 R rS e/4Ve rk eCk 69
City: -P69, ±- L u C J C Stater
Zip Code: `f q V (o Fax:
Phone No "1-1 A- ZD / - G045S
E-Mail 10Ry9tAs+. ?4C1 faN7.zyl4co0e4sf
State or County License G C o .2.Z T I Lp
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
��SURPLEMENTAL Gt�NSTRUCi��C'1N LIE{ LAIN INFORMAT
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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 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 O T JOB=SBF- E THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YO LEN �NEY BEFORE RECORDING YAUR NOTICE OF COMMENCEMENT."
Sienature of Own
ctor as Agent for Owner
STATE OF FLORIDA
COUNTY OFF
The forgoing instrument was acknowledged before me
this day of 20 �iby
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produce
(Sin ur otary Public- Sta of Florida )
Commission No. (Seal)
LASHAHNA INGRAM-RAHMING
aturig of Contractor/License Holder
STATE OF FLORIDA ll
COUNTY OFJ_L
The f ling instrument was acknowledged before me
this day of ftAP k-, 20QD by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(' nature of Notary Public tate of Florida )
Commission No. HAHNAING N t MING
*= W COMMISSION # GG 275060
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