HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ) ��
Date: 3� /� Permit Number:
Building Permit Applicata®n
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 Residential I/
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PERMIT APPLICATION FOR: V.�.��
PROPQSED.INPROVEMENT LQCATION _ � a
Address: Z°I l "� GYM ' � �- `L•
Legal Description: SQA PLaage
Uly 1737-2-i92—
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Property Tax ID#: i 3 ��. d��® /4p 1 e G Lot No.
Site Plan Name: Block No...X-79
Project Name:.
Setbacks Front (-1f'6fi ll--6 Back: 1(,o Right Side: 3LeftSide: 76
a WO(zo
DETAILED QESCRIRTION.Of WORK• �� A
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/0- 124-394
I G+`
AI'6"
CONSTRUCTION IN:FORMATIC+N ,, ��` �
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Additionalwork to be per orme .. under this permit—check alt at appy: !
Mechanical Gas Tank Gas Piping Shutter's ''' I Windows Doors
pg — /
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—Electric —Plumbing —Sprinklers —Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor: ;
Cost of Construction:$ o • cO Utilities: —Sewer _Septic Building Height:
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OWNER%LESSEE. CONTRACI'Oljr " T a
Name Name:-, I.
Address: Company: :s.,;4 =i
littiG;1 a ,� ,
City: IF—*• 3� sr, State: FL Address:
Zi Code: �.,;
Zip 14,9T," Fax: City: w,,TpaGidr:fsbno %,',;:;; Fri State:
Phone No. '7"7y— 9— Zip Code: fax:
E-Mail: `t'—' �" �7� �' Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.;
SUPPLEIVIENTAl CONSTRUCT#QN l'lEN LAW tNFC}R�MA : 0
.�: . .. _
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.
Signature.of Ow r/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ,�_a,�,�� COUNTY OF
The fo going instr ment was acknowledged before me The forgoing instrument was acknowledged before me
this 61 day of 2oa by this day of 20_ by
(Name of person a cknoViledging) (Name of person acknowledging)
$ign�ature�&NotayPu�blic-tttate of Florida) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced ., — Produced
LASHAHNA INGRAM
Commission No. •�t�``p"°�:%� Notart(�'e$�) :State of Florida Commission No. (Seal)
Coriun.Expires Dec 20,2018
Commission#FF 177249
REVIEWS FIR -SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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