HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: non
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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: A(C v
PRCI�+D p1NPROUEMENY LOCAT 01 r
Address: d
Legal Description: C �)J()Cr
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Property Tax ID#: 13a - 0`4 GQ I a 0 y Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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AddC®`NS�TR�,�C�TI,�O�N N'FORM-Ai`I'ION:
itio or to a per Orme under this permit–check a that appy:
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: $ �� Utilities: —Sewer _Septic Building Height:
Name C vn cco Name: CIV Imm
Address: t4 11)G )-2 kd Company: T-CO"0LAJ'
City: Ick \&a State Address:
Zip Code: ' NA-C-11 Fax: City: State: 47
Phone No. I\-a` U"('15 Zip Code: Fax: Q a I–51 t'/'9
E-Mail: Phone No
Fill in fee simple Title Holder on next page if different E-Mail Qtcc12rd,a l0 �. Q�� �QI►�
from the Owner listed above) State or County License Q PrGI�/
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
0040
NSTRUCTI®IN LI'.EN LAW INF®RMATI®N:
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 k or recording our Notice of Commencement. /17
SignatrFFLO
er/Lessee/Contractor as Agent for Owner Signatur " ctor/Lice der
STATurRIDA STATE OF FLORIDA
COUNTY OF , o COUNTY OF
The forgoing instrument was acknowled ed before me The forgoing instrument was acknowledged before me
this t t day of 2t� by this_--day of a 201�p by
(Name of person acknowledging) (Name o erson acknowledging)
(§ign9tur6 of Notary Public-State o lorida ) Ign Lure of Notary Publl State of Florida) \
Personally Known OR Produced Identification Personally Known OR Produced Identificationy
Type of Identification Type of Identification
Produced Produced
•i-as •r1S c•}�Q• �'
Commission No.' (Seal) Commission No. (Seal)
N tart'Publi
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION q"� r o My CMA.. c�j,`�p 2
COUNTER REVIEW REVIEW REVIEW REVIEW R omRFsYi FF 177
DATE ,_.,..,. - ou9h National Notar
RECEIVED LASHAHN INGRAM�
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DATE Notary Pu iC
COMPLETED =• My Comm.Expi es Dec 20,2018
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eV. ���';� �F`°``� Bonded through National Notary Assn.