HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO/MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '3 i 3 �[ (k Permit Number: Igb� -1)9
09
C0'U.I JT 44°
F L 0 2 I D At
Building Permit Application ,„„.._ Rao
Planning and Development Services St/-446. 44)
Building and Code Regulation Division 40cie Pel
2300 Virginia Avenue,Fort Pierce FL 34982 a€o�e/k
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
.PROPOSE,D INPROVEM „ LOCAiIONg. .°°t° g. % .� ;- ''...
Address: -5-3 0 7 (/) ► IV leek GA 2bii?U retoy t( 1”rr'/1 ca {L 3 y25 j
Legal Description:
Property Tax ID#: 1.3 O 1- ;Co 1 S" O o/O - 000/e , Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
AILED DE�SCR PTION- ,WORIQA. 4 re i °
I
‘e'//4/1 o LJ --;-, W( — i6V7e -/o ,1 — 0116 i /rvj , Gc1 ,/ -4/?*T,
� icib I /c (7 - c /��dlpurr►s i
CONSTRUCTION D IF®RMATIONo. '";;%. v .. .' . .° . , $a -x t. , ,
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers —Generator —Roof Pitch
F -..
Total Sq. Ft of Construction:_ Sq. Ft. of First Io;icr. -
Cost of Construction: $ 11 Utilities: _Semler"'',,,1 i Septic Building Height:
OWNER/LE�SSEE7 , a e, -7.s , CONTRACTOR° .• fl h s
Name s)/ Y-Bo c i///,l Name:
Address: 337/ 4,Nir? 6,q ,:,v 1)04) y Company: Ay/4_
City:('-1 �,i 26-i a State:)-/ .. Address:
Zip Code: 3(1Q.6- / Fax: City: State:
Phone No. 7 70., 9 7/ 0 9c 7 Zip Code: Fax:
E-Maila)44Da i%svoeu 6-/Vl4/L , 6 ti 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.
SU 'PIEMENtAL CONSTRUCTION LIEN N1 INFORMATIONg
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name:
Nerve: �. -
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 your Notice of Commencement.
(1110%
i natu - of� Owner . •ssee Contractor as Agent for Owner Signature of Contractor License Holder
(STATE
g / / g g /OF FLORIDAl�-t STATE OF FLORIDA
COUNTY OF -1-1 �-Q COUNTY OF
The forgoing instr,�ment wad acknowledged before me The forgoing instrument was acknowledged before me
this day of r1/4-1‘0- `-'‘• , 201K by this day of , 20 by
Dan NA, fT` old'i -c
(Name of pers U acknowledging) (Name of person acknowledging)
' LASHAHNA IMG•
(Signature of - .,•t:.f} A°' erof�Floill�topi Florida- (Signature of Notary Public-State of Florida)
F r;I� UOmm.Expires Dec 20,2018
�9rF USC
a Commi,g sion-'E
Personally Knowri''t�����` A��� �011ce Iet�i���ti. Personally Known OR Produced Identification
Type of Identifi�atl'n °a18rY�atn, Type of Identification
Produced . _, Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE .
RECEIVED
DATE
COMPLETED
ley. 7/2014