HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:! iri(0`( O
Building Permit Application
Planning and Development Services
Building and Code Regulation Division UG EL I Ivy
2300 Virginia Avenue, Fort Pierce FL 34982 n
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PRQPOSED INPRQ1fEMENT L 'CATIC:3lV
� .
Address: 113 &J, Crl-e- fir• •-Co -� l?ley'"
Le gal Description: ?,- 14-46--
P operty Tax ID#: [ 4?) 0-DOCS-S n QD Q - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
J i
I'-p-ETAILED DESIPION a WQRI :
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7p'�M&Ie_ S 6� __b&u4>4-6 � c)o 4nU ���!'� `(a 91 1�xd(Pfr ��bnC�vt+ 7A 4n60 anyr-1 b
�LaCIL n• e `` Lu (��D • e s a
CONSTRUd C3N (NFORNIATIQN �3
Additional work to be pertorme under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutter) .Windows/Doors
I
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction:, Sq. Ft. of First Floor-
Cost
loor:Cist of Construction:$ Utilities: _Sewer _Septic Building Height:
011UNER/LESSF� CONTiCTOR"
Name M/, Name: c)v-
ddre s: �� �� VC�� Company:(A S� (�c�'s4vv�i'� � ' klgA -�u�=NZ' .
&V.7" // • �--� �1
City: Q'A �etfCQ State: t. Address: `(�(�.. �� -n tom !•
Zip Code: 34qq& Fax:
Phone No.-772,- �` �" Ss� ode: (L Fax:�(4 -
E-Mail: •- Phone No -)7'�_71 •-,-S7_-S-:7�
Fill in fee simple Title Holder on next page(if different E-Maiiertl •a_-)dlh 77.1PC—
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from the Owner listed above) State or County License iPC—t)06��
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFC?RNIATIQN
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 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 allrespects, 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 w9kk or recording our Notice of Commencement.
6.( l cf )rS--7-1
Signature of Owner/Le see/Contractor as Agent for Owner Signature of`o ctor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFCOUNTY OFA
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thioR� day of web 2C}J by this Al day of 20M by
k,JLI—
(Name of person acknowledging) U (Name of person acknowledging)
AQ2 L-CI"
111
( ' ature of Notary Public-Stae of Florida) (Signa re of Notary Public-State of Florida)
Personally Known ,�O t Produced Identification Personally Known OR Produced Identification
�s.
Type of Identification ,.� ,,,,, �==-���t_.., Type of Identification
Produced J, LA5rtgF� roduced ........
AA INGRAM ,,�°�� �s�-,, ASriAHiNA INGRAM
My larY Public-State a/
Florida ' * = Notary
:�.
°QS ° FxPires Dec 20 Commission No. =•: I'Seal)'State of Florida
Commission No. 2018 *p- ��Y Com}n,Exp;res Dec 20,
, Bond dthrou h �FF 177249 �: 2018
OF'Fl��`� Commission FF 1772 A
8h Nation "������'
anonal No Assn,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MA
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014