HomeMy WebLinkAboutBuilding Permit Application ' I
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ALL APPLIC�iABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ?S t Permit NumberdIN ON -
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
PROPOSED IMPROVEMENT LOCATION: !� j
Addlress: Q.3 )(v MACM`4L Oe-0� 1?\✓O\• . `� e►^cJz� ��-- 3�9yq
Legal Description: Rev AOF Fo✓A- �i ecce- S�OY'e� (1lyti} y (3LV— 30 I✓d'r �n
Property Tax ID#: `7 6 0 3 0 0 — �� 2 Lot No.—
Site Plan Name: 12-6E12- Block No.
Project Name: C Atz pe'
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF.WORK: a
�J,S 1`/0-l_(�I�-r i fV D F 51 )C a�Amof u f Q r-s
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CONSTRUCTION INFORMATION:
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Additional work toe performed under this permit—check a appy:
EI HVAC F]Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
❑Electric ❑ Plumbing O Sprinklers ❑Generator ❑ Roof Roof pitch
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Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ S, 3 1'Z-- 1 I Utilities:ll Sewer[]Septic Building Height:
'WNER/LESSEE: CONTRACTOR:
Name l i 'yCOOP-I 1 M• G-te✓' Name: % V'i Avv► OIYI aSSe
Address: a31lp A'T1d[w - c- j3e6L('1-' vd , Company: 1 J_ %nrri CA �A
City: F4. 7z 2 i-c 2 State: Address:
Zip Code: 3Ltq 40 Fax: City: fir. `�;er"CS2 Stater
Phone No. -77 Z — cta L/ -- 5174 Zip Code: 3�{qS) Fax: ??z"-7 9 1.5-9U
E-Mail: Phone No. 77'2--
Fill in fee simple Title Holder on next page(if different E-Mail: AV 1'1 urri cakes1 t LA- k-k 'S%tic-'a-)
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from the Owner listed above) State or County License: A 43 9 LJ
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL,CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
N'aIme: Name:
Ad'd ress: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name:
Name:
Address: Address:
Y'.
City: Cit
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I c,'elIrtify 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 f Owner/Less a/Contractor as Agent for Owner Signature 01 Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF V. oo. COUNTY OF 24 )k "Q i—
The forgoing instr ment was acknowledged before me The forgoing instr ent was acknowledged before me
this day of 20� by this day of 20� by
Name of person making statement Name oofperson making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification j
Produced Produced
4at1re of Notary Public-State Florida) (Signa of Notary Public-Stat Florida)
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Commission No. Se Commission No. .�� �Seai
LASHda
AHNA INGRAM r,_ . $`-LAS4AHN7sltateof
State of Florida 1 °"'�
Public 11d �'Oa1'`'�e'' Public r
Notary E ,� �;- Notary0 2098 � = fi
`' (( +` MY Com'issio d#FF 177249 l r missi , #FF 1 ,,,.�,�����
REVIEWS FRONT 'zOM EiRV1S( PLANS VEGETATO: �,(aughNf�11IJCVdff.-:,
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COJN�'ERi REV , z;��: •REV(EVI/ REVIEW REVIEUV RE.�IREVIEVI�
DATE -
RECEIVED
DATE
COMPLETED
Rev.8/2/17