HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED, ., )
Date: Permit Number: /Yo v��l
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" "'" Building Permit Application
Planning and Development Services 11
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:
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„PROI?.OS,ED IN'PR01%EMENT LOCATI.C}N,,
Address:.'446q 1- ammrsn(_ \rane_ 1'oQ\ PieSCR_j FI
Legal Description: d
Property Tax ID#: d�l Oap - o , :Lot No.
Site Plan Name: i Block No.
Project Name: I'
Setbacks Front Back: Right Side: Left Side:,: i
DETAILED b8 RIPTIQN O WORK.;•.'
n '� S�r✓� � I I
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CONSTRUCTION INFORIVIATIO`N =
E wE
`. e a
itiona wor to a pe Orme under this permit-cheER a I I that appy: i
_Mechanical _Gas Tank —Gas Piping _Shutters ; ; —Windows/Doors'
Electric _Plumbing _Sprinklers _Generator. 'I': `✓ Roof y . Pitch
Total S Ft of Construction:
Sq. y I 6.0 sF Sq. Ft. of First Floor: �
Cost of Construction:$ i 3�1�:C) Utilities: _Sewer Septic Building Height:
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OWNER/LESSEE. CONTRACTOR
Name,(11( tzc� ANn rt eQ QHeT Name: n 4
Address' b`
�}uA C�raksamrxx�� \Arnim_ : Company: 1 -`rn
City: Stater i60
Zip Code: 3`' 143\ Fax: City: r'{ S'Fii Stater
Phone No. Zip Code: a�-ncb"? Fax:
E-Mail: Phone No 71'6. GSbS
;Fill in fee simple Title Holder on next page(if different E-.Mail e-o"I
from the Owner listed above) State or County License C�� 1`3311"2 0
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.!
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SUPPLEMENCONSTRUCTION LlEN LAWN.I,NFQRNIATION
TAL .
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 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
commencin• Work or recording-your Notice of Commencement
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Signature of.Owner/Less ee/ContractaLas Agent for Owner Signature of Contractor/License older
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF COUNTY OF .1 �
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this J' day of �fYtij,ock ,20J_t by this day of 20 Iq by
(Name of person acknowledging) (Name of person acknowledging)
(Si atu of Notary Public- ate of Florida) ( ignature of Notary Public-Aate of Florida )
Personally Known .,OR Produced Identification ,,, ersonally Known OR Produced Identification
Type of Identification t `.�1
L;; i 51VH Iiewrtrnv� ype of Identification.
' Nc:ary rbolic-State of Floral 1
Produced c _ * = roduced
Comm.Expires Doc 20;201 it! • "SHAHNA IN6RAM
Commission #FF 177299 ;�`PRYr,e��- L,
s n ,�= Notary P hlicI State of Florida
Commission No. Bc( fLal�roughPlationalNotaryAas . ommission No.. '. * • IS
_ My Comrp.P'a�1�es Dec 20,20113
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Commission #FF 177299
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ROOM AL,H...IU
REVIEWS FRONT ZONING SUPERVISOR PLANS. VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Te-v—. 7/2014