HomeMy WebLinkAboutBuilding Permit Application i
i
ALL APPLICABLE INFO IVIUST:BE:COMPLETED FOR APPLICATION:TO BE ACCEPTED I !1 n�/1
Date: Z Permit Number: l ��U ' IIPJOL
m
Building Permit Application
Planning and Development Services
Building and Code.Regulation Division
2300 Virginia Avenue,:Fort Pierce FL 34982
Phone::(772)4624553 Fax: (772)462=1578 Commercial 'Residential'
PERMIT APPLICATION FOR: p
To Select from dro box, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: j
Address: 5-LLE <5uSo,-) LY2 • F4- Kea-Le FL 3cf'g5)
bGl`neS S -v -eA 0��� — 'Lo�
Legal Description: 1
QV 3/5-9 - 2:225-)
Property Tax ID#: I I - SOS SO 000 - Lot No.�
Site Plan Name: ��t 1 �U Y-cz) Block No.
Project Name: Z-t���
Setbacks Front Back: Right Side: Left Side:
FDETAICED DESCRIPTION OF WORK:
i
S--Y E V&i-�l"
C�127S6 k T3 t\) S k-\,-VT C-%t2_&
,CO STRUCTION INFORMATION:
Additional work to e performed under this permit-c ec a appy:
I�HVAC Gas Tank ❑Gas Piping _Shutters, Q Windows/Doors
Electric 0 Plumbing OSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Q
Cost of Construction:$ -1 i Utilities: Sewer E]Septic Building Height:
;OWNER/LESSEE: " CONTRACTOR !!
Name L�Y-) � L a lS urs-- P 4- Name: ' 1 Sse t
Address: SLio S &soh �Y7 Company: _V l-- AuY'r--�
City: e r'c,e State: Address:_ IQ() � 1 v�
Zip Code: Fax: City: Q--(-c Q State:'-'FL-
1
tate: FLj Phone No. `Z0 6 9 0 9 ' 7'f-7 Zip Code: Fax:. `7-72-�
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: c�V�1'l ►' �Q1�P���.��rers h�
from the Owner listed above) State or County Licenser 3 Ct
m a,1.Co
If value of construction'is$2500 or more,a RECORDED Notice of Commencement is required.
i
SUPPLEMENTALCONSTRUCTION LIEN LAW I,NFgRMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
ICity: State: City: State:
,Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name: '
Address: Address:
j City: City:
Zip: Phone: Zip: Phone:
i
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.
i
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 use's 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 Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License;Holder
I
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF o COUNTY OF
The rgoing instrumen was acknowledged before me The f rgoing ins merit was acknowledged before me
thi day of 2�2 by this rday of 20 f) by
Name of person making statement Name of per—son-making statement
Personally Known, OR Produced Identification Personally Know�li I _OR Produced Identification
Type of Identification Type of Identification
Produced Produced
&A""Y\ i
(Si nature of Notary Public-State f Florida) (Sig ature of Notary P'ub ic-94e of Florida)
Commission No. e`�l'I1 Commissio N
S,
LASHAHNA INGRAlA LASHAHNA IN RAM
Of
:•2 e a�: Notary Public, State yp
Florida
Notary Public State of Florida '��`� Ue`'�'' 01B
My Carnm.
V ssion# F 49 'N• °�° p,l��fission#FF 17 249
REVIEWS ° ZOO S PLANS E" N ,af{ifr4 TIENot r ROVE
C U� � �� IQ ugh Kali n 1}1/ REVIEW Bone EW
DATE j
RECEIVED
DATE
COMPLETED
Rev.8/2/17