HomeMy WebLinkAboutBuilding Permit Application i
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 'I U3 �oa3
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:
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Address:
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Legal Description:
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Property Tax I'D#: � a(p X03.OI(o/• 000 1 { Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front _'�,.. Back: Right Side: Left Side:
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Additional work to be pertormed under this permit—check a tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _:Windwos/Doors
_Electric _Plumbing _Sprinklers _Generator oof
Total Sq. Ft of Construction: ���G ` r Sq. Ft. of First Floor:
9 �
Cost of Construction: $ U'� Utilities: —Sewer —Se PtiC
Septic Building Height:
=- `�-8 : 'fid w
OWNER/LESSEE �' w ; CONTRACTOR:
Name Name:
Address: o L, Company:
City: PSL. State: Address:
Zip Code: f Fax: /r,� City: State:
Phone No. 7 a` �7� 7�y Zip Code: Fax:
E-Mail: Phone No
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.
SU�PPLEfV1ENT%1�L CONSTRICTION LI�� • Lr4U1l`�1l�FORIVfA1'ION ��•L• �q� P �
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 w or recording our Notice of Commencement.
Signature o er/Lessee/Contractor as Agent for Owner SignaturerRIDA
Li se Holder
STATE FLORIDA. STATE OF
COUN OF Sk.L. � COUNTY
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this dA, day of NCS 20_L by this X day of rY,,o., 20AL by
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(Name of person ackno dging) (Name of person acknowle ng)
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(Signature of Notary Publi -State of Florida ) ign ture of Notary Public-S of Florida)�
Personally Known OR Produced Identificat' n Perso• n OR Produced Identification
Type of Identificat "�°' ' �h Type 11: Licati
LASHAHNAINGRAM
Produced "�'�• Pro E r SASH
-' `" al'', jaFyPublic-State of Florida
•;r «; M' Comm.Expires Dec 20,2018 _". ;-• y Public.State v�M
Commission No.- N.• «ae: t v; MCo da( )
Commiss((5e#I F 177249 Corrtmig ► r._ EXPirec Flori al
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Bonded through National Notary Assn. c?U
Bonded n#FF l77 99018
a -through Nati 2
rrY Assn,
REVIEWS MERONT ZONING SUPERVISOR PLANS VEGETATION SEA MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW . REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.