HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I�UtO Oa'
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:
77p �' SEa�tNEME
� O NT LOCATION:
Address.
Legal Description:
Property Tax ID#: o �0 7 000 Lot No.
Block No.g
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DA�LE1IV
�R1P7�O� OF -71
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At
CNSTI �TN tNbRlfA `tN: .
Additiona ftwor to a pe Orme un ert is permit–cneCK all t at app y.
_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 Q 3 ' Utilities: _Sewer _Septic Building Height:
OWNER/ EEE4 CONTIAK" O
Name LGL Name:
Company:
T
Address: ''� V �' )V
City: ► State:�L...- Address:
Zip Code: -�1�5 t Fax: City: State:
Zip Code: Fax:
Phone No.
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.
� II �
y
_
DESIGNER ENGINEER: Not A licableFNa
RTGAGE COMPANY: Not Applicable
Name: me:Address: dress:
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 thepermit 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.
J
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF_ -�C'� ��� COUNTY OF
The forgoing instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20_L by this day of 20_ by
lit)A A A Qo,&- T ou 1A k
kN Me of person acknowledging) (Name of person acknowledging)
Z/Ognature of Notary Pu lic-State of Florida} (Signature of Notary Public-State of Florida}
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Cfm iss�o. (Seal) Commission No. (Seal)
LASHAHNA INGRAM
�PpY PU�
REVIEWS FRONT Z .'-'r.So tf�t8!$lE9R atep(� a VEGETATION SEA TURTLE MANGROVE
COUNTER R - * WRPqfxpire B REVIEW REVIEW REVIEW
DATE ''rF f F,pp .
RECEIVED Bonded through Nati mat Notary Assn.
DATE
COMPLETED
ev.712014