HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I r
Date: Permit Number:.:
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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:
PRaPOSED [NRRO Ei4 0 i QCATt0N
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Address: `ck Y �yd' ✓�
Legal Description: j;C_ e,1Ar e_57,dr-s * 11- f
Property Tax ID#: 3 C7 e). Lot No.
Site Plan Name: i Block No.
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Pr i ject Name:
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Setbacks Front Back: Right Side: Left Side:
DETAI[�Et3 DE$CRIPTI01� C)E WORK.
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'CO.LV5TRUCTION INFORMATION vs R
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Additional work to bepe performed under this check at at apply:
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X mechanical. - _Gas Tank =Gas Piping _Shutters `' � `' Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _;Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor: e-
Cost of Construction:$ a�D Utilities: —Sewer —Septic Building Height:
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C+WNERJLESSEE: P
�, , CONTRACTOR
1`Name:_�.1.14.:.� "',lnlG ��r S
:Address: -ea.S�b 1 ���r �� j Company: �'' 15c«.Y?i1
City:,aL - `i'. State:fir' ...Address:
Zip Code: 3 1i"a Fax: City: 1--ioi–f ��tr�wor State:
PhoneNo.
'��- -(.�7 /. Zip Code: ,Fax:
E-Mail: Phone No 7 ).1 – /7 7 (�
Fill in fee simple Title Holder on next page(if different E-Mail 61,tJ (A)A -t-ycs/t6 kale . 49k_4
from the Owner listed above) Dator County License, �4�
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SUPRIE'MENTAL C'NSTRUCTI,ON Ll LAW IN`I=ORIVIATIaN
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.
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Sign4tuTe of Owner/Lessee/Contractor as Agent for Owner .Signafure.of Contractor/License Holder
STATE OF FLORIDA Q g STATE OF FLORIDA l
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowled ed before me
_
this rM day of �� 20M by this �iay of V_ 20F6 by
I 111 C. Z*71 .d.
(Name of person acknowledging) (Name of person acknowledging)
ignatu�Notaryto of Florida) (Signature of Notary Public-Sta of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identificatio
Type of Identification ��:^• -^� •-�-�- '' - 7pe of Identification,�..���•�-••--=�
„�����,, LASHAHNA INGRAM LAStiAtiNA INGRAM
Produced y o•a�P� oduced i a� % tic State of,Florlda
tJotary Public-State of Flori aIluttily
C m.Expires Dec 20,2 18 r Wolf._« *. My Comm. x fres Dec 20,2018
Commission No. = ' '�-' C mmission No. + Q Commisieal);F 177249
9 Pc,. `'� mission#FF 177249
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,Bonded through National Notary A sn. ,,,,,,,,,� Bonded lhrough,National Notary Assn_
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA-TURTLE MANGROVE
COUNTER REVIEW -REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED '
ev. 7/2014