HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1910?- L J q-7
6WIa
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: II \-
PROP SED INPROUEME"` IbcATION
Address: fV (� I' ,, (l q t
Legal Description: � cA.o_JJp od �a[: 1 Q n ''A- Q H� � � 1 /��U't C_ ecS
.Property Tax ID#: �(1 ! �� ��U�C) Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION:OF WORK
r CAj
CONS UCTION INFOR(FORM
it 'ha workto a per Orme under this permit-check a that appy:
echanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
Electric _Plumbing _Sprinklers _Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
O�
Cost of Construction: $ qq S Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE.4 ro r CONTRACTQR4 � �,�. ....
Name . �, :;,' �I;, -Name. (.0 G�(AA
Add;�essl Jj c'aJ .�1 >Comp
City: Q lQ->Lk s,t•. '"` State:'. e Address:r
Zi Code: '� (� 5 Fax: City: State:
Phone No. Zip Code: Fax: '7 72-LO DI
E-Mail: Phone No a
Fill in fee simple Title Holder on next page(if different E-Mail lC11 �`a .@ (1C)\
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.PPLEIUIENTALCONSTRUCTION LIEN LAW INFQRIUTATION
E
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
commepe-krig work or recording our Notice of-Commencement.
Signature" ofewner/-LVrTe Contra'ctor'as'Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA C � STATE OF FLORIDA
COUNTY OF Nt_ u a J COUNTY OF
The forgoing instrument was acknowledged before me Theforgoing instrument was acknowledged before me
this�day of� 2011 by thisBo15 day of 20 11 by
(Name of person cknowledging) (Name of p son acknowledging)
s
(Sign t e bf Notary Public-St a of Florida) (Signature of Notary Public-St4e of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identificati .
" �"' LASHAHNA INR
Produced W-m-,
_,_ Produced •
LASHAHNAl ? �= atary Public-State otF*Idaotar 'Commission No. Y Public.State ion No. t O .E ea49c 20,?®f®Q"Rl-Expires De �° COMMISSIon#FF 177249�,$Q9 ' i i��.�OflttAltsfon EFF dalNdthrauph Nation2l P177 Q
ough National�!ntar,
1 Ass
REVIEWS FRONT ZONING SUP VISOR PLAJS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014