HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Nlumber:.
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 ResidentiaV
PERMIT APPLICATION FOR: L
PR {}SptROU1T OCA"(" tN
Address: 3 [A J,4 V �S �- �/, "� 7X 6 _
Legal Description:
Property Tax ID#: Lot( �l�, 'Ute - �C��� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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itio.na workto a per orme un er t is permit-check all that appy:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ ��D.Gd Utilities: —Sewer —Septic Building Height:
{ Vt1NERLESSECONTIfiAGTO� ���I
Name 42,1,1 4-& Name: -2 %Ci �
Address: D /I/ G P� / ; Company: I� AA/t
c
City: Stater Address: 45-,e-f1 A..ffe-T G�-
Zip Code: :2Zi n9 F6 Fax: City: SState: /0�:�
Phone No. T 1 -2 Zip Code: *7C7, i%Y,? Fax:
E-Mail: Al Phone No
Fill in fee simple Title Holder on next page( if different E-Mail 4 = oa'
from the Owner listed above) State or County License G i2 130 l 1(9 P-
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
I
-StUF 'LENiE�T L CONSTRUCTIC}[ �N LAW INFpRMATIQN °
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: Stater 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 reco our Notice of Commencement.
Signature of Owner/ s e/Contractor as Agent for Owner Signature of Contra-Kr r/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of CJ ,20_Z.�by this 0day of —o ,204 by
(Na a of person acknowledging) (Name of person acknowledging)
(Si na ure of Notary Pub ic- to of Florida) \ (Si ture of Notary Public- )§to of Florida)
Personally Known OR Produced Identificationy Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No.�OO l� Seal) Commission No. (Seal)
M LASHAHNA INGAAM ."'Y� LASHAHNA INGRAM
Notary ublic-State of Flori a =r°. .`�? Notar Public-State of Flori a
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COUNT 9,' �EWCom issicRE1QfEW7249 EVIEW REVIEW Q Con misA177249
DATE
RECEIVED
DATE
COMPLETED
ev. 712014