HomeMy WebLinkAboutBUILDING PERMIT APPLICATION.1
016,0LICABLE-INFO MUST BE COMPLETED FOR APPLICATION TO.BE=ACCEPTED
Date:l - Permit Number:
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Building Permit Application orT
Planning and Development Services ��� �A p mkt I 12018
Building and Code Regulation Division �OU ® eg tong p Pa
2300 Virginia Avenue, Fort Pierce FL 34982 (� p� t cj�25un meat
Phone: (772) 462-1553 Fax: (772) 462-1578 Commerdif +� .��� �a�� esidential �/ ty
Properl
Site Pla
Tax ID#: _jP60—O6D't5--OGbsS Lot No. 15'
Name: KP.Gi[,. 4,L}-rao Block No.
ame: o
Front Back: 30 Right Sider Left Side: an
_Mechanic -al _ Gas Tank _ Gas Piping
_Electric _ Plumbing _ Sprinklers
Total Sq. IFt of Construction:
Cost of Construction: $ 3 5DDD
_ Shutters _ Windows/Doors
_ Generator Roof 15 /.2 Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
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Name 1 r
Address.
Company:,
• •
ZipCode:31jqq!�
Phone•
/Code:
Vp "ice. .o pi
Phone No
Fii..An fee simple Title Holder page (if different
E-Mail
frorrAhe Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
i
All APPLICABLE INFO MUST BEL&MPLETED FOR APPLICATION TO'BE ACCEP iD
nnte� 1 Permit Number:
Building - Permit Application
Planning and Develo ent Se ices
Building and Code Reg ation Dbision
2300 Virginia Avenue, Fo Pierce\FL 34982
Phone: (772) 462-1553 ax: (72) 462-1578 Commercial Residen al
PERMIT APPLICATION OR\
Address:
Legal Description:.
I
i
Property Tax 'ID #:
I
Site Plan Name:
i
Project Name:
Setbacks Front Back:
Aaaitional worK to oe perrormea un
I
_Mechanical _ Gas Tank
_ Electric _ Plumbin
Total Sq.I Ft of Construction:
i
Cost of Construction: $
Left Side:
•mit.— cnecK an tnat a ry�
Gas Piping _ S hers
Sprinklers _ Gene for
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
Lot No._
Block No.
Windows/Doors
— Roof Pitch
Iding Height:
OWNS /LRONII
CO TRAGI'OR:
Name
Name:
Company:
Address:
City: State:
Address:
_
Zip Code: Fax:
City: ire:::: 04 .,,:. State:
Phone No.
I
"Zip Code: ~ yf Fax:
E-flail: I
Phone No
Fill` in fete simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
I
State or County License
IIIf value of'Iconstruction is 2500 or more, a RECORDED Notice of Commencement is required.
I
5 P1L
011111CN II
YQ ATtON
QESIGNER/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, 1 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 fq'r
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 attorneybefore
commencing work or recording your Notice of Commencement.
Iez2 YU�
.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this h day.of nor$, , 20]t�, by
this day of 20_ by
Name of person making statement.
Name of person making statement.
Personally Known . OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Prod ed
Produced
i
Si ture of Notary Public- State of ftbrida)
(Signature of Notary Public- State of Florida)
Commission No. eal) LASHAHNA INGRAM
Co',, mission No. (Seal)
�J p�V PVA4
Notary Public -State of Florida
N
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SEATURTLE
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COUNTER:•
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REVIEW
REVIEW
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DATE
RECEIVED
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DATE
bOMPLETED
Rev. 8/2/17