HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i;
/� O
Date: �l Permit Number: 'n 1 1 -0SQ'1
JIMM BUilding Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 I,
Phone: (772)462-1553 Fax: (772)462-1578 Commercial I Residential
PERMIT APPLICATION 01k:
PRO 'to SED 1'NPRQ�/E ANT L0{CAT *, _
Address: 1 / 7 III-e.r 9�v/ J e•�t�� �,GacLi _ �� 3yys Ali,
..tt � o �1
Legal Description: �P//�ef 1SIAnl��hG '22 -272. ' �, `37�
Property Tax ID#: 41 02 ' 5-0/_ 194'70 000- I
� Lot No. yyy
Site Plan Name: Block No.
Project Name: y9�
Setbacks Front' Back: Right Side: Left Side: is
E I ®CM- . aaION
4-Qr� lkAe tvehAo,7 Qn . .. • , .moo ina/ o w'ls
41' .40/ 7�10,e or',4 r'00..IV7
II
Additional worK to be per Orme un er this permit-check all that appy: II
_Mechanical —Gas Tank _Gas Piping _Shutters —Windows/Doors
_Electric _Plumbing _Sprinklers _Generatlor Roof
Total Sq. Ft of Construction: 4 �� Sq. Ft.of First Floor. d 0�
Cost of Construction: $ /700.00 Utilities: Sewer _S�ptic i ; Building Height:
s:.
owN ?R L OHIOo
Name—,To d•6f MOO �' S Name:
Address: 59W P17010s4 Company: ars IW4 Sor ioc
City: 195i__ siSS�1/11/1429State:0/Y Address: 6/ 'i .E ! ���ri' S
IZipCode: 1-5-0.210k Fax: City: 7 oa,; 1442a � State: Az.
Phone No. q/6 3Y9� ' '- 82 8-8018 Zip Code: 7 Fax: 771232,2/%/
E-Mail: Phone No 775' 2ZO -3715_
Fill in fee simple Title Holder on next page (if different E-Mail etaa, Ikmi-A.4 yvl - eOrn
from the Owner listed above) State or County License 53_1981
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. i
SIJPR AMEN' AL CFJNST {U 1"I0N L1'E�N LAW INF®:R�M Tf®N:
DESIGNER)ENGI _ Not Applicable MORTGAGE COMPANY: plicable-
Name: Name:
Address: Address:
City: tate: City: State:
Zip: Phone Phone:
FEE SIMPLE TITLE HOLDER: _Not A le BONDING COMPANY: Not Applicable
Name:
Address: Address.
City: City:
Zip: Phone: Zip: P e:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work—a—ndlmtallation 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:roo -additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to-another-hon-residential
ther-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 cordin otice of Commencement.
Signature of Owner/Lessee Contractor as Agent for Owner Signature of'Contractor/License Holder;.
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY COUNTY OF S
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this L 1 day of �� 20 n by this_4�a day of /V6Y ,2d"1 by
(Narne of person acknowledging) (Name of person acknowledging)
(Signature-bf Notary Public-Sbte of Florida) (Signature of Notary Public-State of Florida)
Personally Known `211I �roducedldye : .A ING Personally Known OR Produced identification
Type of Identification ; Notar p Type of Identification
Produced Y ublic-state of Florida Produced
rF �� ft'iY Comm Expires Dec
20 1111111 ,..-
Gonrnrs� 2018 '% P& LASE AHNA INGRAM
FF 177249 :MR )
°
6ondc A Commission No. ,ic-State of Florida
Commission•No. (Seal)1 .� ,,ryAssn. - tij
:sYCommrF,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION, SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
re—v.7/2014