HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
`�
Date: Permit Number:
tr s
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:
PRO'PQ ES D IN:PRi OEMIF
11TLOCATI40tiN�� s
Address: 'Q 7e2- UG P-ftl jo!2 r
Legal Description:
Property Tax ID#: , - f • CON. Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side,-
1:A 1.r'A I
ide:WOR
j2� /3vS 124—
'J 1,
CONSAMA
TRUCTIO N INf' 1012 N
,,)§R_;
Additional work tone pertormea under this permit–check a tat 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: $ Gl�/U Utilities: _Sewer -Septic Building Height:
I
Name tC'614 C Name: .1 v�N X IL4�-
Address: tLd e 4y, Company: L -9"
City:CAVAh fM0t109L74h State:GVi Address:
Zip Code:-h 9 i o ,9x: City: t -S L C' State:
Phone No. Zip Code: �`'L 3i Fax:
E-Mail: Phone No 71..�_ -Z 7
Fill in fee simple Title Holder on next page (if different E-Mail c oG,til Sl s /�a/r �Gf2•
from the Owner listed above) State or County,Licensei
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.'J
I
SU'PPL MiENTALCO NSTRUCTNXW' LIfNI MEMO INiNE''P TION`:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address: a
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 our Notice of Commencement.
Signa. re of Owner/Lessee/Contractor as Agent for Owner Signatur of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF � .1LQ_� COUNTY OF
Theorgoing infNument was acknowledged before me The fo ping instrut t was acknowledged before me
this day ok N J, 20ttA by this day of 201,by
TZNA k ! 1 J nA.s�.�
(N a of person acknowledging) (Name of person acknowledging)
0 rs
(Sig re of Notary Public tate of Florida) (Sig e f Notary Public-State Florida)
Personally Known OR Produced Identification Personally Known c OR Produced Identification
Type of Identification Type of Identification
0,
Produced
Produced _ .. SHAOtar HN
`,,,�P�Y„�B, LASHAHNA INGRAM Commission No. ="� *µms;A4 Com(5 I� ) State o�M
Commission No. �� Nota EROlic-State of Florida tek Florida
o.,' Commissiopr es Dec 20 20 a.
=N» ate My Comm.Expires Dec 20,2018 gnnded fhro n FF 177 18
:.
Bonded through National Notary Assn. nal Notarygss�� �
REVIEWS FRONT - ZOiVIiVC�-`�- .•-�t�E-E;2ktl�SO:R=�
PLANS VEGETATION SEA TURTLE �VI�AI�GRO //
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.