HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: j j 0007—
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:
PROPOSED INPRO
<. ... VEMNTLOCATION .. b
Address: 3 m S �( 2 cc-
Legal Description:
Property Tax ID#: &.2 y O d 2 E- Lot No.
Site Plan Name: k (V-p- ��t` o� ��✓lam vsk Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF�WORKg
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Additional work to be perrormed under Ms permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
X_
""a 'CONTRACTOR � ��
Name Name:
Address: _ - Company: 01111—P
Cit s/ State Address: D
ZJ
Zip Code' . --S if Cee Fax: City: FI pC.E Stater
Phone No. / Zip Code: 3 Fax:
E-Mail: —� Phone No -Z2 2 - 73 5-Z 46 Z
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW IN.F.ORMATION
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: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 recordingyqur Notice of Commencement.
Signature of Ener/Lessee/Agent Signature 'f Contractor/License Holder
STATE OF FLORIDA STAT OF FLORIDA
COUNTY OF L mac. COUNTY OF 4$l�_�.
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged_before me
this 8)- day of V—'6,3 ,20 LS by this c:;k day of VNJt 1 ,20)� -by
(Name of person acknowledging) (Name of person acknowledgin
Sig toe of Notary Public-State f Florida ) ature of Notary Public-Sta of Florida)
Personally Known OR Produced Identification Personally Known OR r
Type of Identification Type of Identification LASHAHN
,,.�,.aY��e�;,,, public-State Of ,orida
Produced u pHNA INGRAM Produced Notary
te of Florida - . ---MY Comm.Expires Dec 20,2018
;o �8 -, Notary Pyb49
l ��es Dec 20.2018 Commission No. �a• "oc Com �a#onal Nola?y Assn.
Commission No. rtt
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REVIEWS FR ING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
CO NTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/203.4