HomeMy WebLinkAboutBUILDING PERMIT APPLICATION1 I
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ! Permit Number:
Sk Lucie Cdui V
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
PERMIT APPLICATION FOR:
3 S.
Legal Description:
mop rt rT I D #: 2— 2
Site Plan Name: .
Project Name:
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Setbacks Front Back: I Right Side
I L'a /-/ o Z—,3— l4-,E> J` ,
Mechanical ZGas -rank I Gas Piping
Electric _ Plumbing I Sprinklers
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tai Sq. Ft of Construction:
st of Construction: $ Utiliti(
Name
Address: ) 2 !�= P/ P'L
City: S R-r .d U C it ! State:
Zip Code: !s 9 % Fax:
Phone No.
E-Mail: ,< rti ,i-4,SlS' b IT, , L�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Left Side:
F
Shutters
ZGenerator
Residential
Pei . �qR oc?41e
St.'4 0
<Uc ee C �hty
i1
Lot No._
Block No.
14R
Windows/Doors
Roof Pitch
Sq. Ft. of First Floor:
s: 1c Sewer IL/Septic Building Height: �
Name:
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
I
DESIGNER/ENGINEER: "
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
f
'Name:
Address:
I
Address:
City:
State:
City: , State:
Zip:' Phone
I
I
Zip: Phone:
FEE SIMPLE TITLE, HOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:,.-,,.
Name:
Address:'
Address:
City:
City:
1
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 al 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.
x�?4�-
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0'e,
Signature of Owner/ Lessee/Contractor as Agent for
Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
�p\
COUNTY OF SQ,�� �n .
COUNTY OF
The f rgoing instr ent was acknowledged before mle
The forgoing instrument was acknowledged before me
this. day of 20�!Z by
this day of 20_ by
(Name of person acknowledging)
J(.'at)u?e
(Name of person acknowledging )
of Notary Public- State &f Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification , ,_ �.
-
ype of Identification
Produced LASHAHN
I INGRAM
roduced
o.2ty P�BG
r „ Notary Public
Commission No. i s • ; . M f I}n. Expires
tale of Florid
Dec 20, 201
a ommission No. (Seal)
".• "o;: Commission
# FF 177249
%f F;°;% atio
Bonded throu h Nnal
Notary Ass
.
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