HomeMy WebLinkAboutBuilding Permit Application (3) 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
PERMIT APPLICATION FOR:
.11 sell,
Address: 9, S. GG Looxef,3 Rd•
Legal Description:
Property Tax ID#: 34A too a ' 000 1 ` Mo.- 5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks. Front Back: Right Side: Left Side:
r �
Aon
Wiffitionalwork apeormPeu Ps permiWch WItWpp
✓Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction:
`` Sq. Ft.of First Floor:
`-I
Cost of Construction:$ -1 L 3 Utilities: —Sewer _Septic Building Height:
Name U oWlo Name: bf-C YY10rGcL"V1-\
Address: p9d0q E(U0.rris 2G Company: au'-t1n '�lc�C�(�CL �-4COL��1rlL,C�►'Lp� C
City: F -lc P s ere State:FL Address: ►301p> t�1• :F�Lo'ri 60- NXCLrLe'o R-6-
Zip Code: 3 401�a Fax: City: w 2Sk, pc�-lwl- (:5 G -(- \ State: r-t-
Phone No. -1—I d • 5-1-7 - o)(D(0 Q Zip Code: 33L cf1 Fax: Sco t. LA 2-0�Oa-
E-Mail: Phone No SIpJ -` t4 k-1•S-ICt 0
Fill in fee simple Title Holder on next page(if different E-Mail S���c7,� •�1�r idc�lnxltinQ Oe�p 1,
from the Owner listed above) State or County License C-IPTG 1 s k g O B
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
1 ,
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 ishereby 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 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 Owner/Lesse /A nt Signature of Contractor icense of er
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 . day.of ;20 : by : this day of ,20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known . OR Produced Identification Personally Known OR Produced Identification.
Type of Identification Type of Identification
Produced roduced
HAHNA INGRAM41
Commission No. "d���'�, " �� ��
«�c,; "ll(Se'al. -state of Florid ommission No. �� HAHNA INGRAM
qPR n�6'�.
_ . w: My Comm.Expires Dec 20,20131 ;20� ��� Notary Public-State of Flori a
• #FF 177249 __ * = my Comm.Expire Dec 20,2018
°� ded th ough Natioro,"!otary " N," `o`: Com ission#FF 177249
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COUNT REVIEW REVIEW REVIEW REVIEW r - `r
DATE
RECEIVED
DATE
COMPLETED
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