HomeMy WebLinkAboutBuilding Permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: lJos-ml
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1S53 Fax: (772) 462-1578 Commercial _ Residential
PERMIT APPLICATION FOR:
PROPOSED INPROVEMENT LOCATION:
Address `
Legal Description:
Property Tax ID#: O �— Lot No.
Site Plan Name:' Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DES � � � k fi3 - r� ,
CRIPTION OF WORK: u }� �� N x i
(= a _ L
1 zaL avj 5FILK Roof S' S
CONSTRUCTION INFORMATION:
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Additional workto e per orme under this permit—c ec a tat apply --
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _ Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: 7 Sq. Ft. of First Floor:
Cost of Construction: $ gia I 1 ,,C2_ Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR: ���ew
A� �*'` 5�
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Name D ��C7►� Name:D Addres : i QS C�vtj(fi•� L lC�
City: • z7r-� State: _ Address:
Zip Code: Fax: OO City: 7— �L State:
Phone No. ��.�'' � O�z Zip Code:34 4 !r1— Fax:
E-Mail: Phone No ' l
Fill in fee simple Title Holder on next page ( if different E-MaiIJq2QD&S
from the Owner listed above) State or County License f
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
IAA.CONSTRUCTION LIEN LAW INFORMATION:
T e
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 y ur property. A Notice of Commencement must be recorded and posted on the jobsite
before the first in ction. If you intend to obtain financing, consult with lender or an attorney before
commencin o or recording our Notice of Commencement.
Sign caner Lessee ontractor as gent for Owner Sign r of Contractor/ ense Holder
STATE OF FLORIDA ST TE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 2N) by this day of 20_ by
(Name of erson nowledging) (Name of person a nowledging
g n a tVr e o otary Public-Sta of Florida ) toe of+N�otary Public- e of Florida )
Personally Known OR Produced Identification Personally Know OR Produced Identification
Type of Identification Type of Identification
Produced Produced ey
Commission No. (Seal) Commission No. *�`�= NotarLASHy �IwGRAM
M Y Pub c State of Florin+.,
LASHAHNA INGRAM yC omm.Expires Dec 20
NotaryPublic-State o o ida "'_'" Bor 1774,
REVIEWS FRONT ZONINGY O `����Pffd I 018tANS VEGETATION SEATURTLE' MANGROVE
COUNTE `' REVIEW,nc is 7724 R♦fVIEW REVIEW REVIEW REVIEW
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DATE
RECEIVED
DATE
COMPLETED
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