HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �J
Date: Permit Number: 7 '0 30
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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
a
PERMIT APPLICATION FOR:
PRQPOS'ED INPROuEMENT�LOCATIOyN,. � s
Address: � �Z /\3k_A-) COC- C.
Legal Description: I4ov- 6O ulf
Property Tax ID#: ' I "ISG 1. o I 607,4 ocx)—C Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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D"ETAILED D =SCRIPTION MEW
OR1 ,
CONSTRUCTION INFORMrrrAT10'N
Additional work to be pertormed under tis permit-check a that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
ODUNER/LESSE. COACTOR;
Name: , Nil[l.wv- . (._.�� 'C—
Address: &mpany:
City:PG State:F& Address: Z,00Z �.0 Prt'Lor�►'�� de E1"`
Zip Code: Fax: City: P Sir I State:
Phone No. Zip Code: 3"I 0rS-Z Fax:
E-Mail: Phone No 7 74 –q85"8y/2–
Fill
Fill in fee simple Title Holder on next page(if different E-Mail " �l �o ►`� ''�
from the Owner listed above) State or County License (
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU'PP'�EM�ENTAL CO'NSTR�U�I®N LLE�N LAW IIV�FORMATI®N;:
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 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 fir"spection. If you intend to obtain financing, consult with-lender or an attorney before
cor;ftrn,ericjpg w k or recording our Notice of CommencAment.
Sign atu o Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLOR111t, STATE OF FLORIDA
COUNTY OF COUNTY OF �u ,
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of , 20_ by this day of ,20_ by
S: 0 rA Vaao '�)N,^o_z& I ,
3(Naeof person acknowledging) (Name of person acknowledging)
1
(Sig ure of Notary Public-Stateof Florida) (Signature Notary Public-State of lorida)
Personally Known OR Produced Identificationy Personally Known OR Produced Identification
Type of Identification Type of Identificat�o
Produced , Produced „YII�IIYY,.
LhOlIANNA INGRAM
Commission o: Norary Public-Sta(S@�f�rida I
Commission No. (Seal) �jec 20,2010';J
OF F40pB Commission #FF 177249
IIIY
Notal yAssn.:�
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ASH HNAINGRAM
REVIEWS FR T,,, o OI�,NC pool cSI�PERVISOR `, PLANS VEGETATION SEA TURTLE` MKGROVE
COU _ '�)�IF V t� mm. pinREVIEW .1- REVIEW REVIEW REVIEW REVIEW
DATE '��y OC CoRimiS=Ion t' r
RECEIVED
DATE
COMPLETED
Rev. 7/2014