HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 20/1 Permit Number: l l a�) - ioano
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: To Select from dropbox, click arrow at the end of line
I?ROPOSED IIViPROVEMENT LOCATIPN . A
Address: qt,'0,2 o 11-VC
Legal Description: ��QnLqZ AJ �lC S 20 r %ek . ✓. ��
Property Tax ID#: �l (�/ - O(J�Z - O� Lot No. /1 y,
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
IJETAILED DESCRIPTION OF WORK y 5
�F ;�rS r�-� �� / � :.mss /IOP tl 200 ic
CONSTRUCTION INFORMATION
s
a z
itional work to be peOrme under this permit-check all appy:
❑HVAC Gas Tank Gas Piping _Shutters Windows/Doors
11 P gQ
Electric ❑ Plumbing Sprinklers Generator 910-of Imo/ Roof pitch
Total Sq. Ft of Construction:(,! S . Ft.of First Floor: �SOd
Cost of Construction:$ Utilities:i Sewer Septic Building Height:
01NNE`R%LESSEE CONl"RACTOR
Name Q,90 Name:'N I ckarw ' /4C
Address: aZ 6AJ 0 116'4 v Ue Company: (�6ao /til a 4d vv00 '7q ,
City: State: ^ Address:11 —I-7ct I �E �V1•4�f 9-�/k �
Zip Code: Fax: City: 2Di2J !�t ��(' I P -
State:
Phone No. 17 3 7 O Zip Code: �i2 Fax: ) 4c��
E-Mail: ((\1Phone No. -7-7 fZ q _7 b- 9-? / - (/ -z—
Fill in fee simple Title Holder on next page(if different E-Mail: K\C l4i L t'1 rt -Gu k 0 Ic 1/k41
from the Owner listed above) State or County License: U_�COa7
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU.PPLE1111ENTAL CQNSTRUCTION LIEN LAIN lNFC)RMATIQN.3 _.
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 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.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID% STATE OF FLORIDA
COUNTY OF IAaDA COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of O\Qn_CNC1 20 _nby this day of jf�, 20 _a by
(Name of person acknowledging) (Name of person acknowledging)
(S uof Notary Public-Stat f Florida) ( ature of Notary Public- tat f Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
-aa.1S�'U(P -�.oq
ommission No. (Seal) ission No.
LASHAHNA
INGRA ` LASHAHNAINGRAM
e of Floridap... uStat to of lordamwv
flw +�.�?NlyCommExpiresDec20.20 ? " , My Comm.Expires Dec . -,Revised 07/15/2014 ? Commission # FF 177:" ' � rommiss,on aFF 1772-rh Nal.,
REVIEWS FRONT IVI G SUPERVISOR PLANS VEGETATION SEATURTLE. MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS