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HomeMy WebLinkAboutBuilding Permit Application f All I PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: ! Permit Number: (�� ©��� Building Permit Application Planning and Development Services Biuilding and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 hone:(772)462-1553 Fax: (772)462-1578 Commercial ��f Residential PERMIT APPLICATION FOR: Address: d a K— V 1'e-,-) (-31 D G- Legal Description: I PiopertyTaxID#: NO &015 -0000 - won Lot No. Site Plan Name:' Block No. Project Name:; Setbacks Front Back: Right Side: Left Side: itiona wor to a pe orme un er t is permit-c ec a tat 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:$ Utilities: —Sewer _Septic Building Height: Name ri l i -H- :/Ul e r f r` Name:�­eotj f Address: S,3S v2d f� � aG� Company:A-ei�}�iS..:1�'e•gc� L-�-C e--L,-4 State: Address: Zip Code: 3 o2-c� Co 0 Fax: 9? 'X9 5-,20'31 City: 'Vcr6 4rF­4 State: PhoneNo.�r� '� ��- ' 03 F- Zip Code: 3a-1 Z Fax: 9999 995--R03� E-Mail: Gl sys'•Cef1c e- I/ayido*, co r" Phone No 999 -9 9 9- 2©3 � Fill in fee simple Title Holder on next page(if different E-Mail from the owner listed above) State or County License Ego 7T IIf value of construction is 2500 or more,a RECORDED Notice of Commencement is required. DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: Not Applicable 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.. . Signa ffie of Owner/Lessee/Contractor as Agent for Owner Signature ontractor/License Holder STATE OF FLORIDA STATE OF FLORIDA � COUNTY OF Qttg9 COUNTY OF The forgoing instr ent was acknowledged before me The forgoing ins ment was acknowledged before me this day of 20_ by thiszja day,of 2(N% by (Name of persona nowledging) (Name of person knowledging) liatu4reo otary Publi State of Florida) n ure of Notary Public-St a of Florida) Personally Known OR Produced Identification Personally Know rodueedJd_ i '% LASHAHNA INGRAM Type of Identification. — Type.of Identific'tip�a� Ee�, Produced_ _ .:.�.—yam' `" SNANNA INGRAM produced '`A �`�; Notary Public-State of Florida Public-Siate of Florida `� T. mm.Eypires Dec 20,2018 ,`o,P , Notary res Dec 20,2018 9l \o,,, -.,,Fo}F�oa, Commission :S 9 Commission No. = 4 :My Com�Seal) y772g9 Commission No.' n ; I,yrough P;a('sq, onal N�tar Assn. ae Commission*�Fal Notary Assn. - y y E( h Nation Pr A REVIEWS- FRONT ZONING SUPERVISOR _ PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Te–v—.7/2014