HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
All AP
Date
INFO MUST BE COMK.;�.'2D FOR APPLICATION TO BE ACCEPTED
Permit Number:
�■ SCANNED'"'
BY
t. LudsC00RECEIVED
Building Permit Application JUN 15 min
Planni g and Development Services 'ermitting Department
euildi and Code Regulation Division mi
2300 Jrginia Avenue, Fort Pierce FL 34982 i_ngle County
Phon : (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PER IT APPLICATION FOR:
pRO
• P, 0911111RENTa ATION: ii
res W®Wf-; `ia1 VQ
Legal D scription:
Pro e Tax ID # 1301.. LV l l• OatQ, Oo `f Lot No.
Site Pla Name: Block No.
Project ame-
ffige-Mk s Front 01A Back: a Right Side:. Left Side:
DET ILED Q,, F`` S •RIPTION QF%1 K:
r� hr.rL.kA 5VA 41A. U✓ 1\ he- RnC1d r
CONSTINFORMATION:
Additio ial worK to be pertormed under this permit- checK all that apply:
_M chanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors
E ectric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total ScFt of Construction: Sq. Ft. of First Floor:
•ost of Yonstruciion: uSC� Utilities: —Sewer _Septic Building Height:
VIJ £R/i.E�StS E:
"N. TRACTOR:
Name
0 0" T5. `mot -
Name:
Addre
Company:
City,
! erC State:
Address:
City: State:
Zip Code: 3 gcl6- Fax:
Phone
No. 7 i'Z - S(g1 ` i y IS'
Zip Code: Fax:
E-Mail
, 7 ".
Phone No
Fill in i
a simple Title Holder on next page ( if different
E-Mail
from t
e Owner listed above)
State or County, License
II If value I
construction is 2500 or more, a RECORDED Notice of Commencement is required.
5 PPl.NJWAi. Tk Gl" I N 0 EN LAW lNiF • RM 7 CJN.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
-Name:
Address:
.,Name:
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 on the jobsite
before the first inspection.. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as_Q-e7eor Owner
Signature of Contractor/License Holder
A
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
nt
The for oing instru was acknowledged before me
The forgoing instrument was acknowledged before me
this R day of 20_a by
this day of 20_ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification V
Personally Known OR Produced Identification
Type of Ide tification
Type of Identification
Produced
Produced
( ignature of Notary Public-,Sta of'Flbr.L[OW)aHNA INGRAM
(Signature of Notary Public- State of Florida )
;eon Notary Public -State of Florida
�`cz
Commission No. _ My Co1SPE #1)Pires Dec 20. 2018
Commission No. (Seal)
Commission #� FF 177249
��irFOF PL�`� National Notary Aasn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
&Z�
RECEIVED
DATE
COMPLETED
Rev. 8/2/17