HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR.APPLICATION TO BE ACCEPTED
Date: Permit Number:
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 Residential 1✓
PERMIT APPLICATION FOR: �rlCe
Address: X 625 j57d /c! C SSS T$"44U - 10jeY-ce J 9
Legal Description:
Property Tax ID#: l� /� ' 12�� 00�5_- ODD Y Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Additional worK to be perrormed. un er this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: /�Q�t Sq. Ft.of First Floor:
Cost of Construction:$ �°'I 17• Utilities: _Sewer _Septic Building Height:
Will
Ndhi6 Name: IC' C4C�
- .
Ka<<�►dd�gss .�,�D ' ,. �c��..(' �Y�r�S p ) �'� � ?
Company:,"' �24e cf► �C
City State• ,; Address
T- �S `tiY.LCaG i C State: I
Phone No. ZLode: Fax:
i�.
E-Mail: Phone No. JG �S
Fill in fee simple Title Holder on next page(if different E-Mail` DC l �7&t 0LA-kl%--•-rte
from the Owner listed above) State or County License <1 cc
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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:Yqur 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 t inspection.",,If you intend to obtain financing,consult with lender or an attorney before
commen(i ork or recordin our Notice of Commencement.
Signature of n /Agent/Lessee/Contractor Signat=ORIDA
tractor/License Holder
STATE F F IDA + STAT
COUNTCOUNTYOF
The forgoing instru nt was acknowledged before me The forgoing instr me as.acknowledged before me
this]_day of 20.f_� by 'this day of 20 jS/by
(Name of person acknow edging) (Name of person acknowl ing)
i nature of Notary P6BI&State of Florida) (Signature of Notary Pu of Florida)
Personally Known OR produced Identification. Personally Known OR Produced Identification
Type of Identification Type.of Identification
Produced Produced
LASHAHNA'INGRAM
,•'2°`t. 0% Notary Public-State of Florida
Commission No. S )fAHNA INGRAM Commission No. '•' ; My C(mIkxpires Dec 20,2018
Notary Public-State of Florida
'.;�� apc� Commission#r FF 177249
+ Ex ares Dec 20.201 ° ;� Bonded through National lusty Assri
'Comml Sion#FF tri: ;.
REVIEWS FROM I@�,�tedthr u�lN LAMS VEGETATION SEA TURTLE MANGROVE
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