HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED
} OCT �� 2: 1016
Building Permit Application
Planning and Development Services
PERMITTING
1NG
Building and Code Regulation Division St. Lucie Corsty, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
-a- t x 1,v a r- - 7�r ,a
PRQPOSED INPROUEMENTLOCATICN - �; � F = " A�£ � '
Address: c� ua;ie1%
Legal Description:
Property Tax ID#: C) 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 all 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:
i,
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
i''R 4221I
®UV,NER/LESSEE 'tl ws ON 111'
A
O,NTRCTOR:
a
Name Name:
Address: ;C Company:
City: State: F)- Address:
Zip Codec" Fax: '�`7a'�59�165 City: State:
Phone No. Zip Code: 7z
, 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
Evalue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S,IJRRLE11lI,ENTAL Cr7NhSl-RPII:�TI'®N. LIEN LAW INFQNI�►TIQN
� . .
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 fir t inspection. If you intend to obtain financing, consult with lender or an attorney before
commenc_iFA work or recording our tice of Commencement.
ignatur of Owner/Lessee/65n-tractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this (�L_d of 20 ' y this day of 20_ by
me of erson acknowledging (Name of person acknowledging)
Sig ature of Notary-Public-St, of Florida) (Signature of Notary Public-State of Florida )
Personally Known '' Personally Known OR Produced Identification
Type of Identificati6 .��`Pd���m,, LASHAHNA.INGRAM Type of Identification
Produced Notary Public-State of Florida. Produced
=•x .�;. y omm.Expires Dec 20,2018
Commission No. FofF4o?�� Commi� eonnl FF 177249 Commission No. (Seal)
nded thro g att onal Notary Assn:
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 4