HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �O&
Date: Permit Number: I - 0361
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: -j� L �oC
PROPOSED INPRO�/EI�/IiENT CA: _3
Address: Q� �� -5e--�72444 3D
Legal Description:
ropertyTax I.D#: Q4 ' 2)1 •'010$• IWL} Lot No.
Site Plan Name: Block No.
Project Name: �LlZ
Setbacks Front Back: Right Side: Left Side:
DNATHIED DESCRIPTION0-11IV®MR]K:
CCINSTR'l1CTf01U IN1
3
RIVlAT10N:
Additional wor tobepertormed under this permit-checTall that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
_Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
rte ,
Cost of Construction:$ �, Utilities: _Sewer _Septic � , Building Height:
OWNER/�E: CONS RACT®R:
Name 7-� 4 Name:
`Address: 'a" > Company: "
City: State7�� "Address: �Z Lv
Zip Code: Fax: City: Stater
Phone No. �/Jam— '/ —l9� ��- 'Zip Code: 345"501 Fax:
E-Mail: Phone No- 7 5-1 J?q -,
Fill in fee simple Title Holder on next page(if different E-Mail Y�S<�g�e:-,0- �G2!
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S�IJJP�P�LE�/IENRA,L CCil N LIEN LAIN INFORI\IIATIQ'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 first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
�? J__'I AAJ4iQ�
Signaturef O ner/Lessee/Contractor as Agent for Owner Signatu e o Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 1� _ COUNTY OF a A
The forgoing inst ment was acknowledged before me The forgoing instr ment was acknowledged before me
this�day of 20—Q by this�day of 20a by
( me of person acknowledging) (Name of person acknowledging)
o
(Signature of Notary Public-S to of Florida ) (Signa ure of Notary Public-State Qf Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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(n 11-0 ;va, l�l� _,- t( e` I`)NA INGRA
Commission No. t(�.gab)HNA INGRAM Commission No. :°e°n� `°�: M
mRY�'Up e"
Notary Public-State of Florida
;aJ Notary Public-State of Florida M
Exoires Dec 20,2016 9o; Y Comm.Expires Dec 2p
Commissi n#FF 177249 1 ;; n #FF 177249
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REVIEWS FRO, %%Fo;;,°¢0N)Ii&Gthroug! 8IJ1 R"M�9� PLANS VEGETATON SEATUR::Tk ughN�7';(0'Gt�QM�
COUNTTR��REVi�%'� REV E REVIEW REVIEW REVIEW �'RE IVF1A7
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014