HomeMy WebLinkAboutBuilding Permit Application •
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED . f l� `r
Date: II--Z �rI s Permit Number: `� ` 4 O'7OT
Call NI irYr Recoveo
F L D R I D .A.
:._ _ Building Permit Application APR-24 ?,
019
Planning and Development Services Permittin
Building and Code Regulation Division St. LU9 Departmeht
2300 Virginia Avenue, Fort Pierce FL 34982 _ �°unty
Phone:.(772)462-1553 Fax: (772)462-1578 Commercial Residential �/
PERMIT APPLICATION FOR:
PR a S OOR Miyari1 .LOCATION. 14.Ay ° , �
Address: 16 701 5 • 0 e €c , •pr, ";Sens ev, &e«cJ' , FL 76 t-1
Legal Description: 1,1c V,2 CXY\- i 5cl C — LO-I- /6. 5
Property Tax ID#: q S-I I ' bC • N 6 S' 60 ' Lot No. /65
Site Plan Name: Block No.
Project Name:
Setbacks Front_ Back: Right Side: Left Side: 1
DET.AILE�D DESCR�IPTI®N OF WORK •T. ,w t � r., � 4n
rs ...,„4,;.",,,,,,q5,1,
��. ..m -. . .... .-„Y.J. +�
- - Alc Cv e- _ i►_:_ 34 , Iif Seer IroKw /-/ecJ-
=C®NSTRUCTI®IV 1'NP®IRMATI'®N°
Additionaltiwork to be performed under this permit-check all that apply:
V Mechanical _Gas Tank Gas Piping Shutters _Windows/Doors'
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ /,Sao Utilities: _Sewer _Septic Building Height:
RLE ` ce® TRAT®R .. . .a ,-0 Aa:L / E:SSP ° m . • ` , .
Name L°-) : 111c.v' R'e.,F Name: .... 4o9 - CQII?aet
Address: ( a 701 . CDCCt&\ 0 f• 1--0'l" 71)y Company:-_,:r6.31-- Ci) 1kaf i,- z/JG •
City: Je�en ,r State:FL Address: /4'9 Sw Sws'tf Ate
Zip Code: 3`*957 Fax: 41/414 City: Por4- SECr,+ 1-uc_c State:FL
Phone No. 56 I - Sog1""�7S`) Zip Code: 3 Y9S3 Fax: •
ev
E-Mail: I 4- Phone No 7 72-323-307s
Fill in fee simple Title Holder on next page (if different E-Mail 3 L'S'A-ci,;1l'i ri--@pvi-(c„,,IS.com
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENT C®NSTRtiUCTION LIEN DAVIN lN.-.ORMATIQM -
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 w• , of recording your Notice of Commencement.
/ - -
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE COUNTY F OF FLORIDA CSTATE OF COUNTY OF ORIDA �..� � _
The forgoing instrum nt wa. acknowledged before me The forgoing instru ent w s acknowledged before me
this Q"f day of \ , 20 ( ?by this 2)1 day of . , 20 ty by
CAN r t.C tp?1^4:6✓ W k`t t. CA It 1 we- Ghd`c -¼ -v Lh t\ Cd lt k
(Name of person acknowledging) (Name of person acknowledging)
Si n(S,
ure of NotaryPublic-State o gna ure of Notary Public- Florida)( g Florida)) \
Personally Known OR Produced Identification Personally Known OR Produced Identification N
Type of Iden ification Type of Identification
Produced kl- — e, Produced . ----1_.
Q .�•Piti:, LASHAHNA INGRAM Rv�''�V4 SN' JNA INGRAM
`� �a� .,A °° Seal) r
Commission No. 2°n ,,`�: Notar(l5.eaIl)c-State of Florida Commission No. ,..,e,'';
- -�: Notar ruuu,:-State of Florida q
, -' o•_My Comm.Expires Dec 20,2018 Nom*_t.am,
* My Comm.Expires Dec 20,2018 i'
',gs��7:4e Commission #FF 177249 -„F.r_7�: COmr.^,IS - ;77249
°” '`'z Bonded through National Notary Assn. °F,,,,, Bonded throw Nations
REVIEWS FROM -r'. ONING `" '• SU PLANS VEGETATIC : T Tt. A °'
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ley. 7/2014