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
PERMIT APPLICATION FOR:
P C)POSED R
INS!Rfl�E��� � �' ,•
Address: C? 7 r
Legal Description: IWO.41 e. I-loM c- 'TrA(L-er'
Property Tax ID#: L90�-' c` nc! x Lot No. 3-3
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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C�,NST UTIONINFORIATION�� �' a } .
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itiona work to be pertormed under this permit-check all that appy:
_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: $ J�(�0 Utilities: _Sewer _Septic Building Height:
=O;WNER/LESSEE a ��uCUNTRAC`COR:
°r�.a *_s � 'F•,4w7Y.� P-
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Namef,Vert I S M 0 d 1 c-f- ff O m 2 M 14 1 ic Name:
Address: L'2 —I.NJ A S 2 Company: r—tf F.--ec-,
City: soNrJ./ ISie-f State:, / Address:_o 4 S fG✓ PA e-
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Zip Code: 331 6 O Fax: City: State: TZ
Phone No. 205-- , S ZQ ?-"L 52- Zip Code: 3 ci q63 Fax:-
E-Mail: Phone No Q /-.115-&- /1'7
Fill in fee simple Title Holder on next page (if different E-Mail Clk e 7-H.SC/'✓rC r?"
from the Owner listed above) State or County License Z-A/3 0
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Address: Address:
City: State: City: State-
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicabl
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'p cihibit 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 recoMing your Notice of Commencement.
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Signature of Owner/L ee/Agent Signature ontractor/Li ense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Zk-1,� COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me,
thisQ-El-day of Cry 201 by this L day of Z36U'L 201 b by
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(Name of person acknowledging) (Name of person acknowledging)
Si nature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida) \ _
Personally Known OR Produced Identification Personally Know OR Produced Identificationy
Type of Identification Type of Identificati
Produced Produced
'R9P'"!"_ LASH HNA I,NGRAM
,� „
Notary Public-State.Of Florida
c°Spar°b�' LAS f INGRAM Commission No.' _,�: °'S MY Comm. Q bec 20,2016
Commission No. a',
n « otary Pu lic-State of Florida F.f.oa°� Commission#FF 17,7249
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My Comm.Expires Dec 20,2018 s` ""'" Bonded through National Notary Aqqn
a mission FF-.177249
REVIEWS .RONT ry F,- d Vf G7h Nati nStOPURMS0R PLANS VEGETATION SEATURTLEMANGROVE
COUNTER REVIEW RE'IEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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