HomeMy WebLinkAboutBuilding Permit Application I � I
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1�,
Date: Permit Number: �Cry&L_• o(D2a-
M
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.)M .w .....N '_ . 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
PERMIT APPLICATION FOR:
PRQPfJSEQ INPROV"'EM, LOCATION
Address: /
Legal Description:
Property Tax ID#: ���. -_��! 0� �� - Q/� (/ �Z� .? Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:'
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QETA(L.ED QE-CRIPTIC►N 4�F WORK• � �' � x �� g �
TO P1940 Z_
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CCyf1VSTRUCTICIN INFORMATION
�.. �. ,e.0 .�•. ,
itiona I work to be peff-or-mi-ed uncler this permit-ChecK all that appy:
_Mechanical =Gas Tank _Gas Piping _Shutters'. (� 4 Windows/Doors
Electric _Plumbing _Sprinklers _Generator ! _Roof itch
Total Sq. Ft of Construction:. Sq. Ft.of First Floor: -a J
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
0111JNER �LESSE , z a, CC}IVTRACTOR Tom.
x
Name' Name:
Address: :
C;' k/ /n ompa��r
'Cr/C State: A°tli?Js: b ;wl/
Zip Code: 71P79- '. Fax: City: i'�P�� OOI t'lrGr'/ State:
Phone No. ?�. �� h Y 7 Zip Code: �' Fax:
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E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail fi $ 'r 00
from the Owner listed above) State or C unty License
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW IT RIVIATIQN
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 r�ppording your Notice of Commencement.
Signature o -inrner/Lessee/Contractor as Agent for Owner Signature of tractor/License Holder
STATE7F FLORIDA STATE FLORIDA
COUNTY OF COUN OF .Ir� .
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thi ` qday of kb. ,20_1Z by thispd day of r-
j 2011 by
(Name of person acknowledging) (Name of person acknowledging)
(Sign ure of Notary Public-State Florida) (Signature ot Notary Public-State&Iorida)
Personally Known '%-n GR�Pmduced--ldentification--t—,> Personally Known OR Produced Identification
Type of Identification ,.R...;, LASHAHNA INGRAM Type of Identification
-e.. ..
Produced ;2°n .`�•: Notary Public-State of Florida produced
My omm.Expires Dec 20,2018 �o,�'"'�B� LASHAHNA INGRAJFlorlda
of cc ;,�. „o s "Notary Public-State ofCommission No. -;, Corgipn#FF 177249 Commission No. ' My Coa)pires Dec 2�,��� onded oY Nation-1NotaryAsn. %a : Commission#FF 17Bonded thro h National Not
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014