HomeMy WebLinkAboutBuilding Permit Application (3) ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:1. 30l7 Permit Number: `
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 X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED",IMPROVEMENT LOCATION":
Address: S -703 RA leo et ✓I e_. Cc El. 19i e ec_e Ej 39 95
Legal Description: I-\OI\ �16_4A �1 n 529 - �ha�e 1 c� + 8 C/�R�? /3 )1-2 A,1
COrL 3802. — z�) 3O
Property Tax ID#: Z D 0C) Lot No. J
Site Plan Name: Block No.
Project Name: ,leyv"ey-
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
T� ZC.ATIQIv 0� t/►V'rI CAV2e s t4-t
IV q) ACG 0 c l o n S�i LA,
CONSTRUCTION INFORMATION:
Acid _appy:itiona workto e e orme under this permit—ceca
HVAC0
Gas Tank _ Windows/Doors Gas Piping Shutters
0 Electric 0 Plumbing []Sprinklers 11 Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor: ;
Cost of Construction:$ 2 I c11 2 Z Utilities:0Sewer 0 Septic Building Height:
OWNER/LESSEE: CONTRACTOR;
Name VI ►^10� C Ply Name: 1 U1�'rf CG1l�Q T
Address:- 57/ pa
03 ,l-eo i"'-_J C.a~'. Company: i'✓' a SSC.
! c1
Y I
City: a. ,erre. State: Address: ( 0 0 Al
Zip Code: .LJ S I Fax: City: Ff . fer''ce- State:
PhoneNo. '7-?-Z- 9 q o 98 SZ Zip Code: ?y qSl Fax: -77Z-7?y-/S 90
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:a J I trG o�
from the Owner listed above) State or County License: 244 39 Y ho mlti .ev
If value of.construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:-
DESIGN ER/ENGI NEER:
NFORMATION:-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: ;i
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 thepermit 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 Jn 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.
s
Signature ofOwner/Lessee/Contractor as Agent for Owner Signature of ontractor/License Holder
STATE OF FLORIDA r STATE OF FLORID ,
COUNTY OF COUNTY OF ►play^-•�.
The forgoing in§tlZiment was acknowledged before me The forgoing insCPe ment was acknowledged before me
this M day 20 0—by this_day o 20 Q by
i
(("eof person acknowledging) (Name of person acknowledging)
Sig ature of Notary Public-Sb0te of Florida) natLke of Notary Public-State of FI ida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Prod c d _ Type of Identification Produced
,,�a,Ry��a,, ASHAHNA INGRAM C mission No. a .
Commission No. -° ( ��Public-State of Flor da •
,.��OFky"�a�,,, LAS HAHNA ING
•: :•=M Comm.Expires Dec R
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State of Fil rida
'=My Comm.Expires Dec 20,
Revised 07/15/2014 Bonded through National Notary Assn. rida
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS