HomeMy WebLinkAboutBuilding Permit Application �I
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: ,I
PROPOSED INPROUEMEN LSCA ,N;
Address: '�JI ot9 PP-Oso,c01a 00LC
Legal Description: �A�i Q two o pos-r - [An i '� I C, " �I� (o��'III Lo r5 � �'nCL
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J JfProperty Tax ID#: 1Q 1 _ Ln 1 _ 011 ul 0®® - ? Lot No.
Site Plan Name: ;I Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE AILED DEaSCR1PT(ON OF WORK:
oLuner c j►11 PL& uf2 ex Lor h't R ock � tle. -L\L ! $a1 . Y)Omo 07c;1 nch °
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CO?NSTR�l1C7I0N I INFORMATION:
.rtional work to be pertormed un er t is permit-check all tat appy:
Mechanical Gas Tank Gas Piping Shutters I' Windows/Doors
—Electric —Plumbing —Sprinklers —Generator —Roof
. Ft.of First Floor:
Total Sq. Ft of Construction: Sq.
Cost of Construction:$ Utilities: —Sewer Septic,,I Building Height:
OWNfRMA LCONTRACTOR.
Name erg. a A J ACV,2�0('o Name:
Address: �/(_% fee BaroG kog Co
City: State: Add ess:
ry,
,. ...,,. �
Zip Code: / (1?S Fax: City: State:
Phone No l - 0 602- 7 Zip Code: Fax:
E-Mail: CSM va Inw.can- Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
i
If value of construction is 2500 or more,a RECORDED Notice of Commencement isrequirei.
SUPPLEMENTAL C�NSTR JCT ION LI N LAW INFO ,IMP I,ON:
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 recording our Notice of Commencement.
i, �
ignatur f ner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
Theforgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this rday of 20J_(B by this day of 20_ by
(Name of erson ackn wledging) (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 Ide 'fication Type of Identification
Produced Produced
�p X_ 1 'Uj 2 BIOS Q
Commission No. Commission No. (Seal)
LASHAH A INQRAM
Notary Public-State of Florida.
xpires D c 20,2018
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