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HomeMy WebLinkAboutBuilding Permit Application 1 ! i ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED, Date: Permit Numlber: [na– 040QLI (c ' Building Permit Application Planning and Development Services I f Building and Code Regulation Division (! 2300 Virginia Avenue,Fort Pierce FL 34982 j Phone: (772)462-1553 Fax: (772)462-1578 Commercial l Residiential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line /Trri h >✓i//j ri / �'lr/ ��/fr/// //i% �i c//// j// ly:. y..ri.N �r// .�/✓..� ,,,...rr id�e_..,,:>, �r�� ,..,;ice ,.r._..,�✓/,,.,.:..i..: ui.�.r..,.,.....r.,wZ��/..✓.r, �..�:... ,,.,r,'�.,,.:�i .,✓.��� .y/,.a,:.�Y /_.,.,,./,� :�/ v...✓u,�.,... Address: 1 ""I ••�� c Legal Description: -�i� ('� , , 3 J 0 Y� T 1--> f Ff 0`wMCJYN �-(e�� 4�� � 1C L I °Z C roperty, I ax ID#: � I L/ ( 2 — 000 i i' Lot No. L-6 ` ��a Site Plan Name: I' Block No.. Project Name: ! Setbacks Front Back: Right Side: Left Side: ! I L4 4 LA ,h F, /i;y//// ,. //r ,., ,<,,,./ 1,/;/, /,,z�i/%/,�////r.///e'/ / � //////•///fes/�z a/// //// /;ir�t, ,« /��6� r F � /l/t//l/ /.i r' f r .i.,. % ;'. L ,';'s, ' ��/i%/�� ,.�,F.s/��jy//z // ,zif y i r:. ,✓ s y;�/ ,:...�E ea %i/- r/ra z .✓i ll,! ,t � .fay, W t G aa y/2 /v /§ y� �� a °�✓,./r /i�,� �f ✓n . x f//f /. ,n. /irwb yy... / ✓ / y a i ✓: g ./f/ y /rrR a 11s / C�NS;TRU If} INF/OR �k ION �r�� /� ;,��� ,sir, /r h.. ,.✓, r/ ,.G ,oaf ./,/�. ,...i.n.✓i/� �.r..r✓or. ,.,.,.roc,.Mr ./P... ,//../yar,/_:,--,//�d�/r /%///"�_�_/:y/cr/,..r✓���r_�/���...r., 'Additional work to be nertormed under this permit-check a appy: I HVAC _Gas Tank []Gas Piping _Shutters Q Windows/Doors Electric 0 Plumbing Sprinklers Generator El Roof Roof pitch f ' Total Sq. Ft of Construction: S Ft.of First Floor: i Cost of Construction:$ ��i�(� Utilities: _Sewer L-1 Septic ; 'Building Height: .:"✓i/ / y i ./. r - / ✓9//i///%i !�/i/r /r///,; /, r /y ""/ r/y r./ r .9/ { / / / / /ya a'//,//,F l;� r,.. ,i ,,r.. / .// / /. r OtIV R � y / /1/ �, � ,/.�C NT Cs £ R <.r c "1� r / /. f, � r fir% ,>vi v #.,,z/<✓„✓/s�/,,,! rr'/d��%.,/„ii i�i/ryr�.�� �,,,may,,l /�x;, �„y .,,.,..,.,...,,,� rra<f/rr,- ,; x<r,7 i.�.,//,� � „� ✓,�y. �"�'>�: Name-T–q r 'Ctq--,ccL r-ze'.f\ 011W Name: �kA. 1'! VAS (Address: C FL Company: City: ©�Y\O. State C N Address: �?0:5 Zip Code: 913O�3 Fax: City: -Pt"A M State: , Phone No. S 05 832 ta-14l 3 Zip Code: `�C!L9,Sb Fax: E-Mail: Phone No. 2) 6'570 L,\2 Fill in fee simple Title Holder on next page(if different E-Mail: ��C�, i lli'S� o��c�� 'e from the Owner listed above) State or County License: I I If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. ! I' I� I i �I xr/ /y,;; o f o [3 - s;./ iriir- SC1PP M ? TR1T,ONj I ` ` 1N NF RMA fy ' ✓,,� „/ � DESIGNER/ENGINEER: Not ApplicableMORTGAGE COMPANY: �, Not Applicable f,I — pp 'Name: Name: ! i; Address: Address: I I City: State: City: State: Zip: Phone Zip: Phi ne: I, FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: I' _Not Applicable Name: Name: Address: Address: I l' City: City: !' Zip: Phone: Zip: Phone: I I' OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to,do the'work and installation as indicated. 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 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. 11.11 The following building permit applications are exempt from undergoing a full concurrency�eview:iroom 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�lin 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 o,r,an attorney before commencing work or recording our Notice of Commencement. OI � + n � vvv,L ��, L� Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA �! COUNTY OFuc,'o COUNTY OF o i The forgoing instru ent was acknowledged before me Thefp oing instr el t was acknowledged before me this day of _ 20� by this 77 day of i 2011 by Name if persotYmaking statement Ngown a of p son making statement Personally Known OR Produced Identification Personally OR'Produced Identification Type of Identification Type of Identification Produced Produced (Signature of Notary Public-State'%f Florida) (Signature of Notary Public-Stat f Florida) Commission No. (Seal) Commission No. !r' (Seal G�P""'ua LASHAHNA INGRAM �.otoY�i��, LASHAHNA INGRAM itY A °, %�: Notary Public-State of Florida =�r *°? Notary Public-State.of °E My Comn.Expires Dec 20,2 18 N o °=ro+YComm.Ex fires Dec 20,2018 REVIEWS FRONT 'rF p INQ:om 1sS19�PERV[&MC LANS VEGETAs It oir �S 'ATlfiRlr sio MANS@,QVE COUNTER �µ' ' V() edthr ughRl \/ IaryA.,snfj�EVIEW REVIEW � EfO �atiorf�PeVOf1Vk/ssn.F' DATE RECEIVED DATE COMPLETED Rev.8/2/17 I , I �,