HomeMy WebLinkAboutBuilding Permit Application 11
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /,;?—( -17 Permit Number:_ lo�.• 03
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Building Permit Application `
Planning and Development Services I a
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 IIUIPROVEMENT LOCATION
Address: c;�.,. 0) a274J-10,17 LC4� �e�
Legal Description: I !
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Property Tax ID#: N3Q•—goto-f) LP .0000 Lot No.
Site Plan Name: Block No.
Project Name: "
Setbacks Front Back:_ Right Side: Left Sidel 1 _
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D§ETAILED
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DESCRIPION OF WORK �a f11II$
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3re:2. `D oor �ae�l�h�c�ii�S �2 ►�0�-2 �� !'gyp�4 c—
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ON INFORIVIATIGN
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Add
itiona wor to a er orme under this permit-c ec a apply:
177 71
HVAC Gas Tank []Gas Piping _Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers Generator ❑ Roof Roof pitch
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Total Sq. Ft of Construction: Sq. Ft.of First Floor: _
Cost of Construction: $ o oUtilities: _Sewer Septic Building Height:
OWNER/LESS{EE s 4 �CONTRACTOR� m
Name -Af'r).1 h 'E_ Name: aosp_peO r
Address: Company: e i l
City: D'f= f?ic_rCe _ State: L Address: S—UO
Zip Code: Fax: City: s f c� Stater
Phone No. 7 z RD_ gc��/� Zip Code:?X ` ' Fax:
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E-Mail: Phone No � O
Fill in fee simple Title Holder on next page( if different E-Mail: 41141_e ' ° ruL-74 �t dog Cu
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL.CONSTRUCTION LIEN LAW INFORMATION
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i DESIGNER/ENGINEER:, Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address: I
City: State: City: State:
Zip: Phone Zip: Phone:
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FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: !Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Ph,one: i
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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 maV restrict or prohibit such
structure.Please consult with Vour 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 A i endme'nts.
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 acid posted on the jobsite
j before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
i comro.Qncingwork or recording/your Notice of Commencement. ;
ure of Ow Csee/Contractor as Agent for Owner Siof Cont�r`c i r/License Hol er
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TATE OF FLORIDA,,,.,,, AVETOF FLORIDA
COUNTY OF , COUNTY OF Ski
The forgoing instr mentwas acknowledged before me The forgoing instrument was acknowledged before me
this day of 20�n by this '1 day of 2011 by
tme personmaking statement Name f per on making statement
PersonaKnown_ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identific on j
Produced FL Produced
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Ignature of Notary Public- ate of Florida) (Signature of Notary i ublic-St* of'Florida )
Commission No. IN �. Commission No
LASHA NA GRANI ,'y1 LASHAHN.RGINIAM
Notary Public State of Florida 2�aq= °��;j 41iJotary Public-State of Florida
Kw nnmm.Expires Dec 20,2018 ;fd'iy Comm.Expires Dec 20,2018
=N x `o` Commissi n#FF 9. F commissionr,
REVIEWS FR .z0�,11,,N4, hrougt h3lU'C�� {SCI 'J PLANS VE E" fa y17
i ll��R�aEtonalN t? VE
COU ,REF/i€\7Vy'`'"`REVI6' REVIEW R' f , �
RE�IEV1' REVIEW
DATE ;
RECEIVED !
DATE I ;
COMPLETED
Rev.8/2/17
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