HomeMy WebLinkAboutBuilding Permit Application i
All1APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED] �jz3
Date: Permit Number:
F 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:
i TMN ,
"'M
MQSE0,1NPROVEEJ
Address: 2- r` L'�1IJ k �
Legal Description: y-rJ0-_ rV\-0,_ QYNC- } A �, S, Lao 12
ii
Pr perty Tax ID#: 1 � �(� (�� — ( }� _� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
i
'71
pETAILED DESCRIPTION OF WORK. -
j "ti. R J PS44r, s
CONSTRUCTIC N INFORMATION Y ' . .
Additional work tobe per ormed under t is permit-c eck all that apply: j
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Xzifoof Pitch
1I
Total Sq. Ft of Construction: . 1 135- Sq. Ft.of First Floor:
Cost of Construction: $ Utilities: . —Sewer _Septic ! Building Height:
i
OVIfNER%LESSEE. j`CONTRAC ORS r I
h, �1 -' ♦�
,Name // Name: }
Addr'e s: j t L Company: .. I i �
City;': State:"te( Address: ! ✓�
Zip,.0 L Fax: City: CIU Ln— tiCState: E/
Phone No. 7 b Z Zip Code:�)�(n1 _5 Fax:
E-Mail: Phone No D']Z- S`-7? - ��
Fill in fee simple Title Holder on next page(if different E-Mail 1!�:,f A,-t. V� -f-���`�p,(,c�,� /���1J►'�:c `�
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.:
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION.
.,... - pp = MORTGAGE COMPANY;
DESIGNER/ENGINEER: Not Applicable 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 .
commencin work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S ,Q , COUNTY OF
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20J2 by this 13 day ofD,e f,, ,20-a by
o.
'Ru
(Name of person acknowledging) (Name of person acknowledging)
le
( ' natu a of Notary Public-Sthee of Florida) (Sign ure of No ary Public-ftaQ of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification :.__ , A _ _ _ Type of Identification
Produced ced ^ate
`""""� LFlSHAHNA INGR M
e' LA',,; FlNA INGRAM
Notary Public-State of Florida a o°''RY�"A<i Notary P::olic cta'.of Florida
Commission No. _• COMM.yExpires Dec,O�PrTI fission No. 'r ($2 If
Commlasion #FF 17'249 VATI'ON'4
«.clvly Comm.Exp ires� c 20,2018
Commission #FF 177249Bonded throw h National Nn REVIEWS FRONT ZONING SUPERVISOR PLANS VEGSEA TURTLE v MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/203.4