HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE
/IN O M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: T 7 Permit Number: 1704 ' ()8Q-o
- Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 /
(hone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PRCIPOSEQ IN.t3R01lEMENT LOCATION :P
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Adi dress: `J
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Legal Description: 'Jaur - L Fr (Q•6
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Property Tax ID#: n91 s/z 6612 C/ - 006 -.~ Lot No.
Site Plan Name: /i �-- Block No.
Prl Jett Name:�PPLcome,,1 0- �rrn Fence
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION;t7F WORK
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CCIN5TRliCTION INFORMATION
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Additional work to be pertormed under this permit-c ec a11 that appy:
_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:$ Iwo - Utilities: _Sewer _Septic Building Height:
0111/N.ERf LESSEEuCCNTRACTOR ;
�. . ,t F :... _ . _,.
Name ' ' le Name. �N:.
Address: t— Company:
City: fir)' P,'�.rFt
ce. - EL State: - Address:
Zip Code: 6gel y-6— Fax: City: State:
Phone No. �'Zoq - o2/(c - ,�9-7D Zip Code: Fax:
,E-Mail: /i') GG. Gi L� Phone No
Fill in fee simp a 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.
S.UePPLEMENTAL CONSTRUCTIQN LIEN LAW INFORMATION
DESIGNER ENG pp MORTGAGE COMPANY: _N p x
ER/ENGINEER: = ° _Not A licable of 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 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 OFLit,0 COUNTY OF
The forgoing instf4ment was acknowledged before me The forgoing instrument was acknowledged before me
this day of 2011 by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
V_SigdatAire of Notary Public-St to of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
LASHAHNA INGRAM
Commission No. 'o`D� °A�':. Notary Pub101,eaIJte of Florida Commission No. (Seal)
4 a•=My Comm. Exp
ires Dec 20,2018
r'.nmmiccinn 1f FF 777A0
!Notary Assn.�f
REVIEWS 'FRONTr- --ZONING. -`SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Te-v--. 7/2014