HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I Ln 01 C)dt 1
I IIIIII�I�I IIIIII�III
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 r; �
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: 1.L1 1l' 2>4 615'a
Legal Description: �'Q ��L-' f �; 1 T �,, -- ( � ` c)±"4
MAID �ZZN 02 33`72 -7`� Z- l
Property Tax ID#: � 0 Lot No. �r
Site Plan Name: Block No._177
Project Name:
Setbacks Front Back: Right Side: Left Side:
cry( w S c io r.\j del r4 O Pt Let Q ( n(rc
Additional 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: --7 Sq. Ft. of First Floor: < <JDy
Cost of Construction: $ / S Utilities: —Sewer —Septic Building Height: ) /
Name -!� Name:
Address: Company: 0.
City: fjA CjOC State: " =t Addressi2
: `=
Zip Code: Fax: City: pQ2- .1to State:
Phone No. `7_7 Z _L1 JS Zip Code: zy S�)__ Fax:
E-Mail: Phone No 1-7
7. —2:�, Q �2
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County License 11:7
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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 your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of contractor/License Halder ���
STATE OF FLORIDA STATE OF FLO
COUNTY OF COUNTY OF 5'
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this�day of� 20Ib by this_(,,o_day of S41&JoA 20 (0 by
(Name of person acknowledging (Name of person acknowledging)
of Notary Publi6-'State of Florida Signature of Notary PufState of Florida
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identificatio
Produced Produced
a 'ASHAIINA INGRAM
LASHAHNAINGRAM Notary F,
INGRAM
0 %
g&e Of Florida
of Florida Commission t'
Commission No. -wary Pub(isezote of Florida ion No. i Y Co
e Dec 20'201 8 Paas Dec 20,2!116
Comm'ssiOn#FF 177249
Comm.Expires Dec 20, 8 F
#
',V-- Commission#
MYC FF 177249 Bonded thrnll�h A
ti. a,NotaryAssn. 11,41 No"'Y Assn,
Bonded through National Notary Assn.
REVIEWS
_
T FT-KVISOR PLANS VEGETA.
ION SEATURTLE NTA CMiVE
51
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
-RECEIVED
DATE
COMPLETED
Kev. lIZ01
4