HomeMy WebLinkAboutBuilding Permit Application ,� ',
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ]�Q
Date: Permit Number: I{ 003 70
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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 Res i',dential V'-
PERMIT APPLICATION FOR:
,4A« OSED IN.PRo1JEMENT LOCATION
Address: I! (S� R�W(M,X.el ,
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Legal Description"7v�)ml%A o•n% LxwtcacatcLI 0T
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Property Tax ID#: - 3 y0 g— 000—O I I x', Lot No.
Site Plan Name: Block No.
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Project Name: rs 5
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK I�
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COVSTRUCTICN INFORMATION € � �RF
itiona work to be pertormed under this permit—ChecK,all that appy:';
_Mechanical _Gas Tank _Gas Piping _Shutters ! Windows/Doors
Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: x.011 Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: Sewer Septic Building Height:
owNER/L.ESSEE. ..a a 3tii'
oIVTRACTOR1
;Name Name: SoL'0\ '
Address:_tog.1���.�JeAfAffil QV Company:
City: r4. oibr e, State:EL Address: 1
Zip Code: Fax: City: State:
Phone No. a(p z223? Zip Code: Fax:
E-Mail; ')(,�glf�6ImLTpb 0.CC)f)Y& �'lo (o 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.
i
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.
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 ppermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and,covendnts,that;rhay.restrictor 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 pea pe fm do h6reby'agree that I will;in all?.respects;~perforrhlthe work
in accordance with the approved plans,the Florida BuildingCodes 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 r'ecord'ed 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. ;
Sign ature,of .,.n /Lessee/Contractor as Agent for Owrier Signature of Conttactbr/License Holder
.. Y
STATE OF FLORIT STATE OP FLORIDA
COUNTY OF COUNTY OF
The forgoing instru, t was acknowledged before me The forgoing instrument was acknowledged before me
this day of 204�_ by this day of 120 by
k
(Namnf person a0no ledging (Name of person acknowledging)
(S' ri re o otary Public-State f lorida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification ersonally Known OR Produced Identification
Type.of Identification - '� Type of Identification
Produced „�����,,,, LASHAHNA INGRAM roduced
,TO t49,Public,-State of Florida d t
F t�� Expires Dec 20,201
Commission No. ` °My(t;� 4lrlssion #FF 177249 ommission No
act
Bonded through National,lota.ry
REVIEWS FRONT ZONING SUPERVISOR PLANS V,EGETATION.. , SEA,TURTLE MANGROVE
COUNTER REVIEW REVIEW. REVIEVff -REVIEW '' "3 REVIEW”"' ` ' REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. /2014