HomeMy WebLinkAboutBuilding Permit Application p
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: �Vl
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION _. � ��-„ '' � � _ _
Address:
Legal Description: S.
I,
Property Tax ID#: �c3®(p '��1 �O� •1 �0 C� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF WORK =
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CONSTRUCTION INFORMATION ;
Additional work to bene orme under tis permit-check all appy:
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HVAC Gas Tank []Gas Piping Shutters O Windows/Doors
Electric 0 Plumbing Sprinklers Generator M Roof
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ Q Utilities:nSeweE Septic Building Height:
OVIINER/LESSEE CONTRACTOR . E'
Name Name: (c. c
Address: Company: FjCe
! I'M!/�
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City: c-P1 State:EL Address: l t
Zip Code: Fax: City: P (zrl�-ei Ii State:
Phone No. - Zip Code:c3 W6� Fax:
E-Mail: Phone No.
Fill in fee simple Ti a Holder on next page(if different E-Mail: ce �� U�CGr fed
from the Owner listed above) State or Coun License:
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N value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPFIEMENTA>*CtJ1115TRUC17UN UEN li4W INFQRMATIQN - 1
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DESIGNERANGINEER: Not Applicable- MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
city., State: City: I State:
Zip: Phone: Zip: Phone: I
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address: d
c.Kty-. i
Zip: Phone: Zip: Phone:
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I certify that no work or installation has commenced prior to the issuance of a permit
St Lrh I Countmakesno representation that is granting mitwill authorize the holderto build the sub structure
wh Ls in cornrfln et with any applicable glome Owners Ass adon rules,bylaws or ant covenants that may restrict or prohibit such
structure.Please consult wrth 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 att3nr brise with the approved plans,the Fkrrida Building Codes and St Lade t..ountyAinendments.
The following building permit applications are exempt from undergoirig 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 fallme to Record a Notice of Commencement may result In your paying twice for
improvements to your properly A Notice of Commencement must be recorded and posted on the jobsite
® before the first inspection.If you intend to obtain financing,consult with tender dr an attorney before `
comff*gdng work or recording our Notice of Commeri�oeme
s
_Signabore of Owner/Lessee/Agent SIghbture of Contracdur/Uwnse Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF •l,, _
The forgoing instrument was adinowtedged before me The forgoing instrument was acknowledged before me
this dayof �n h , 20 ito by this 4o day of h .20_LbN
(Name of ckriowledging) (Name Zperson owledging)
4 Pre of NotaryPublic- of Florida) re of Notary Public-Si Ae of Florida)
Personally Known ti OR Produced Identification Personally Known Oil Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. L (Seal)
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LASHAHNAINGRAM
t ASHAHNA INGRAM .q^?{Revised 07/15/20 "` r"' otary u is- aIN" net� Notary Public State of Florida y Comma Expires Dec 20,2018
ec20,2018 Commissiosf#FF 177299
.a,, Commissfi n#FF 177299 ,r;,•� "
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REVIEWS FR �.oef OV throug tSR4RERVIMR PLANS VEGETATION. SEATURTIE MANGROVE
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COUREW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS YI
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