HomeMy WebLinkAboutBuilding Permit Application 1
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
' Date: Permit Number:`
F 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 .,,' �?
i
PERMIT APPLICATION FOR:
PICiFPOSEO INpROUENT LUCATIONIN,
va
Address:. f S�eL� HY
Legal Description:
f
Property Tax ID#: �l � r'S" �D4-�2. Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Tl
DETAILED G3SCRfP7101 aF 1NQRK \� �
r
KIM10vt s mf rock w4 10-0�rt]
!
CO TR'UCTiC N 1NFORMATIIN'
ona w rK to be pertormed under this permit-checK all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
i
_Electric Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor: i
i
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
N I
CI'iltiER/� SSEE. YCONTI�ATO ,
c
�
Name S'te, tw ^!i -O _5ClName: '0413
Address:o� LID S(J 2! (a �� Z)`Wv1 A ��IV Company:Sfr i 4 f U Ca Sfr C (
City: �CIm Cl State: r I- Address: yD 5►�u a�+NiC S'�
Zip Code: �L Fax: City: LUG? State: L
Phone No. Zip Code.3q 9 oyq Fax:
E-Mail: Phone No 7 72'2-0q `1737
Fill in fee simple Title Holder on next page(if different E-Mail i1C o l 0w as zK141r o- !"
from the Owner listed above) State or County License !, C GC 112-Y
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU '�LENiEN 'GiTRCT1C3Nl. NLA1il (3RNI1T }�
M13
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.
11-2
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORtqk` STATE OF FLORIDA
COUNTY OF 1 COUNTY OF
The#Qrgoing instrument was acknowledged before me The rgoing instrument was acknowledged before me
this c;', day of �i� 20��by this day of 2da by
(N ot person acknowledging) (Na of person acknowledging)
(Signature of Notary Public-Stk4 of Florida) (Signature of Notary Public- ate of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced F L_ Pr duced V\--
LASHAHNA INGiaaen
Commission No. ,,.dY��G•,, �ASHAHNAINGi1AM a�no'�
(Seal" �nmission No. 6 e`er, ti(Sea1`)iblic-State of Florid
¢ Nota y Public-State of Flor d!r ,:My Comm.Expires Dec 20,20' 8
# d-� ."1,Ay Comm.Expires Dec 20,2018,_
` s�� /tea" Bdei h 177
Commission
ommd0ission#FF 177290
GG
aug"'; I 0 l W a �A�
i3 `n3l Not,3rA .1Be
REVIEWS FRONT � o " COR'; VON MANGROVE
COUNTER REVIEW REVIEWREVIEW REVIEW
.P.
REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. /2014