HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST:BE COMPLETED FOR APPLICATION TO BE ACCEPTED 22
Dater 1 1 -7 Permit Number:�' .. 0
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SIGN a
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 ReSldentlal _
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: I
Address: l20 5O "Tw ►-� Creer,s fir-: ! i erg F.I 3y°\��
Legal Description: T W N in Core_e k6S 1 �'S_ �� J- - q -1 J
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Property Tax ID#: 2 3 3 — 0 0 -00 ) — oocD — Lot No.
Site Plan Name: 1—y-c::, Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additionalworkto e e orme under this permit-check all t=appy:
❑HVAC 0-Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
❑Electric ❑ Plumbing []Sprinklers ❑Generator ❑ Roof F Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 3 , .S 5 7 b'?- Utilities:❑Sewer❑Septic Building Height:
OWNER/LESSEE: CONTRACTOR`:
Name o lore's "5y_1 Name: i I ,\ c�sSP�
Address: 1'"137_0 _FL
i K e !� Company: �.I/� L�ln�i�i cGtV�P
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City: � r� � e.Y'd1- State:� Address: 10 0 ,
Zip Code: 3 Ui 9 95__ Fax: City: r Stater
Phone No. -772-- qbg - (' & Df Zip Code: 3LA�5I Fax: 772-79(4-/YW
E-Mail: Phone No. -7-7-1— `7 q q -1,YS)
Fill in fee simple Title Holder on next page(if different E-Mail: c�V 1 V1�iV��cclYi�t N t�� nc Wha}/nai 1�
from the Owner listed above) State or County License: AL1 �Gl�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:-
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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 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 holcerto 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.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of ontracto'r/License Holder
STATE OF FLORIDA STATE OF FLORIDl
COUNTY OF COUNTY OF 9..
The forgoing in ument was acknowledged before me The forgoing in Tent was acknowledged before me
this m day ot 20'aby this3day o 20 I� by
( rie of person acknowledging) (Name of person acknowledging)
NAW
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Sig ature of Notary Public-S e of Florida) (;%aXZ�
of Notary Public-State of FI ida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Prod ce _ Type of Identification Produced
•.`PaY'n'���, (-ASHAHNA INGRAM
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Commission No. •`�` ;°� (� } public-State of Florda mmission No. (- al
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Revised 07/15/2014 ��z �. :. '., o�oto;,. Commission#FF 1772
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS