HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPI ` iID FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Legal Description:
SCANNED Permit Number: ! iQg •
BY
St. Lucie County RECEIVPM
Building Permit Application
SEP 101017
PERMII`TING
St. Lucie County FL
Commercial Residential
4T>
Property Tax ID #: 73 � -- 2'3 3— A=) C:>C;l \ — eb CY5 % Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETrAILED DESCRIPTION OF WORK:
_Mechanical _ Gas Tank _ Gas Piping
Electric _ Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ Qi ro o r:> utiliti(
_Shutters —Windows/Doors
_ Generator —Roof S k-z-Pitch
Sq. Ft. of First Floor: 1� n
s: _Sewer _Septic Building Height: 4� l
OWNER/LESSEE: - _ _
CONTRACTOR:
Nam n ��-C•�
Name:, =+
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Zip Code: Fax:
Phone No. -7"12• ZBS -9&9 7
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Zip Code-_-A�a Fax:
Phone No `I`i-7_ —
State: — L—
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E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Maili'0.�
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State or County LicenseeC L`zs
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If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL GONSTRUGTION UEN LAW INFORMAtTION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 our Notice of Commencement.
Signature of Ow / Lessee/Contractor as Ag nt for Owner
Signature of Co raptor/Licens Holder
STATE OF FLORIDA
STATE OF FLORIDA%
COUNTY OF 51.1 �.°
COUNTY OF�1.uCAs:
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 1-6 day of 20a by
.a...,.n(Name
this � day of 1� 20_0 by
of )
(Name of person ack wledgin
(Signature of Notary Public- Stat&of Florida)
(Si toe of Notary Public- Stat of Florida )
Personally Know OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced r--•--""""
' Produced ^
LASHAHNA INGRAM
C t'pr nyBry•
Commission No. ;r°. ., Not� clip •State c1 Florltla
$� Doc 20, 2018
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