HomeMy WebLinkAboutBuilding Permit Application ni - --ABLE11.1O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED MOU
Date: Permit Number. n'&3
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: Cl C;z't)C
PROPOSED INPROVEIUIENI" L®CATION
Address: Q0ri 'rNv/C.
Legal Description: Swig O O R -S'� 2 2 L C)-F"7
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Property Tax ID#: 14-12 "�7O3 -- oc> 1 7 0 Q O - `7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
�E;" IPTION ®F WORK:
C®'NSTREtJCTIQN 1NF®RMATI®N:
!Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
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_Electric _Plumbing _Sprinklers _Generator i Roof Pitch
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Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ IJV
�(�,pUtilities: —Sewer —Septic Building Height:
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OW�hIiER/LESSEE: CO�NTRACTUR:
Name hvW- PVSS . V-%QL.Oto Name: m.LTJ
Address: Company: / �'kj CLG w, C4-.b.
City: State:_ Address: (O a (, S W!-P
Zip Code: Fax: City: &'r Syxi V1 Lk-K 6 L State:Fc.
Phone No. Zip Code: 31, q 5-?J ' Fax:
E-Mail: Phone No 'Q6)-z-1 h 1 -'81 0
Fill in fee simple Title Holder on next page(if different E-Mail ..�vw%l !�,_;•�r�/t t t �` G,z, A ,L �G�„
from the Owner listed above) State or County License =F=R. ;a-0 l"Y')
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. ;
�Ek1lIEi AL c�NSTR4`01 THE) t 1 4�1� AWN!" t=MT, '-' •=
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.
A—Z
ignature o dwner/L e/Contractor a gent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA 00 STATE OF FLORIDA�,{�
COUNTY OF COUNTY OF �C',L_.•z"ZL
The forgoing instr wt was acknowledged before me The fo going instru nt was acknowledged before me
this day of LZ 20�by this:day of 20-a by
6 &6rd > `
(N a of person acknowledging) (Name person acknowledging)
Na,
(Sig ature of Notary Public- ate of Florida ) (Si at lre of Notary Public-St&e of Florida)
Personally Known OR Produced Identification Personally Known OR Prod uceLidentification
Type of Identification A A
Type of Identification yp a LAShAHNA INGRAM
Produced Produced l 'rn;, ,r1 Notary Public-SYate of Florida
My Comm.
LASHAHNA ING Expires Dec 20,2018
Commission No. nal) i ion No. o F4o, ) 7 FF 177249
'�, ���✓ Notary Public-StateL120.
t Bonded(hrough Naficnal Notary Assn.
K = My Comm.Expires De018 "`—
F�"r`°°' B d r Nat'cn l NotaryAssn.
REVIEWS FRONT ZONINGS-_.i, SURRIPS�3�R;I-1.4' �1-• VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7 4