HomeMy WebLinkAboutBuilding Permit Application All APPLICABLf INFO VUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �" 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
PERMIT APPLICATION FOR:
PRtJPOSED 1lUPR01%EIVIENT LOCATION; 40
' : u
Address: )6 r '/u✓npikec Rede-1- F7 ei-erco rI ?L1elYJ
Legal Description:
Property Tax I D#: Y.30 1- U 15" DO 1 I CG 0- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
dM
D TAfLE(3 DESCRIPT)ON OFW RKY' ;'w y
I '_'- �. P 3.. ,i511
L� k -Q/ L.i lie- 2,1' O®®/ncA SLI Tee.- Ona 6ifR
j2GC'k,4! ,.Q U.-11 4-G,, On -66g _ 1Ja �ltcF
� a
g:'
'
CONSTRUCTIO INFOR , TEON
s ,,
Additional work to . e pertormed under this permit-check all t hat appy:
r�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: $ �OO � Utilities: —Sewer _Septic Building Height:
OlNN EI2/LESS" E9 ap' (�
r-A"N �' x re � :s_O(VTRA,CTORE: } xY't i. aG7'4'
Name P+ S Gf- S i'
LC- Name: ��!>� 2�+� r�1�� cn sA
Address:`. I() K-C- QEM-E:- 0—Li "Company: S q C L-Jo 4-z C-,-'
City: 1:�CU'r_I p)e L C& State: ( Address: 6 q 1,? Cra
Zip Code: 3Iq9S 1 Fax: City: F State: P-
-1a - I - 3 GS �Phone No. - =U- 9
E-Mail: Phone No -11 r 6795-
Fill in fee simple Title Holder on next page ( if different E-Mail 4!�-C(j i 4;:t CRI UtS,ca'1 o c veh
from the Owner listed above) State or County License CA 166029
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S[ P�PLEMEI T �1 Cf3 l , IRt CTIO is Ly ¢N 11, 1"MY 1N C R,MAT',,
,
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 recording our Notice of Commencement.
Signature f Owner/Less `e C tractor as Agent for Owner Signature of ontractor/Li e se—Fiolder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF ,�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 010 20a by this_cgt day of 201-) by
(Nam of perMn acknowledge ) U (Name of perso acknowledg g
�(Sig6atur6 of Notary Public-S6be of Florida) (SihQatiAP& otary Public-Staff f Florida )
Personally Known OR Produced Identification Personally Kn011nm OR_P..roduced Identification
LA .,, ...a
Type of Identification Type of Identificqtiori`';<;>., HaHNA INGRAP
/. ?; i�utary,oublic
Produced Produced ��.,. : . State n!
'om p
Co m.Expires D,
Commission No. ` ,...: :. � �,• Mmission# Seal
(Bead) ommission fro (seal)
LASiiAHNA INGRAFA - w— 90 N
=`f Notary Public-State of Florida
P,4y Comn.Expires Dec
REVIEWS FRONT i9TF I 1,Y�NGCom iso; EtI4 � 9 CLANS VEGETATION SEA TURTLE MANGROVE
COUNTER 1Ededthr ugh k Pnar SinREVIEW REVIEW REVIEW REVIEW
RPT
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014