HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: —�7— 7 Permit Number:17
Building Permit Application
Planning and Development Services
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Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
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PERMIT APPLICATION FOR: DpMO)i7�-O;n
PROPOSED-iN:PROVEMENTLOCATION � g4 P
,..3.. .a, C.S- h ',.ya ... ..
Address: 10701 S 0Ce,4.7 9,r. ,#Y0V J elfel 9:?-rC4 FL. �y95 7
Legal Description: (/eei&e QU f a J1_T
Property
Property Tax ID#: g5-11- J-IO-00057'000 —2 Lot No. PO`s
Site Plan Name: V614 hlee Block No.
Project Name: X0 l .
Setbacks Front Back:. Right Side: Left Side
DEi LED DESCRIPTION OF
,
GOm,Ole-le Wemol'f:®ti a ".,n0Vd/ Q1—' ?dV 5-7(-' �114d d Am e
4 73
71
GOlf5TfRUCTIC}N INFORMATION
Additional work t&-be performed under this permit—c ec a tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: 36y Sq. Ft. of First Floor- 36y
Cost of Construction:$ 1700 0o Utilities: ersewer . _Septic Building Height: 77C
OWNER/LESS ` GONTRACTOR
s,.
_ „ter. .. ..>. . . :,
Name 0,', A„
r%en H•�e c} C1n �z Ilae L.OoV Name: �i7`"h
v n I
Address: /0707 S. Oe e,,,, ,fin /Ofi�O� Company: <srn ��A UOdcah4e.
City: T017fen &4014 *w State: Address: ASI cam, '•5:pe,7cel' 571
Zip Code: 311957 Fax: City: ,TB'1Se' RewCx State: Pz-
Phone No. 772' 5'00- 3W0 Zip Code: N94-2 Fax: 77�-231-219/
E-Mail: Phone No 771' 2, 0- -?7,16-
Fill in fee simple Title Holder on next page (if different E-Mail aa�arn fr„�"f�i G ?/-4�oo -Com
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LA\N INI=0RNIATION
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 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 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 r cordin our otice of Commencement.
Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
Theforgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 2-! day of )e-z� 20 11 by this-'q_day of 20L�L by
(Name of person acknowledging) (Name of person acknowledging)
(Sig ure of Notary Public-Statbe of Florida) (Signature of Notary Public-State o Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification of Identificatio ����
Produced LASHAHNAINGRAM Pr uced 't�RY"�' L
"""", HNA INGRAM
Notary Public State of FI rida + a� � _. Notary Public-Sk to of Florida
Commission No. + ' �(�omm.Expires Dec 20,2rC'�mmission No.. :,�a My Comm.E(;SI�j a
�Q�` ec 20,2018
Comnission #FF 1772.. F;,FF oa,c� Commission
Bonded #FF 177249
9ondr„i thnni ... gv� rz through Nalion 4i %f
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION: SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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