HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED S
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Date: Permit Number:
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FLORID MAY 1�4 2018
Building Permit Application
Planning and Development Services Pen®Chu went
Building and Code Regulation Division
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2300 Virginia Avenue,Fort Pierce FL 34982
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Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED' N PROV"EM ,LOC*ATION° . :` $° n r p
Address: .GU w :U S 4-j.
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Legal Description:
Property Tax ID#: 14a W--Sb/ -OO/S - C)i (0. Lot No._
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: -_Right Side: Left Side:__
DETAILED.DESCRIPTION'CWWOR+Kw ;
ra
12441 tut. 1 in A►1 w, k& , ( s eP- 'Maar 57St.
V t, Loa Ap 141A )i *- eVICAGNIeC
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•CONSTRUCTIO.N INPORMATIONo . # t • ;
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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
Total Sq. Ft of Construction: - Sq. Ft. of First Floor:
Cost of Construction: $ —7co Utilities: _Sewer _Septic Building Height:
O,W�N�'ER LESSEE: �, CONTRACTOR?. m o
Narrie.- P!-fro, �'t9cLp �-Cmc L Name: E kj ulrw+� -
Address: o�y t(0 NV St. Company: 1r.J 1
City: Pf,l I'e&c_ State: Address:1 ' yo1/44,:..frov:1-61w8d4, .4-ctiZ
Zip Code: . 3`( I L/' Fax: City: iState: c�
Phone No. Zip Code: 3qy`fi Fax:
WCC—bcqv
E-Mail: Phone No t((/_0500
Fill in fee simple Title Holder on next page(if different E-Mail w ``+ tit. 001- 01'
from the Owner listed above) State or County License ( (3Oo33 1
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU,P-PLEMENTAL C®NSTRU@+T'ION [ W INFORMATION , .4® , , .
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 rion-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 vork or recording your Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF + .Lt COUNTY OF FLORIDA
L.,1-'`-�--
The ior,going instrument as acknowledged before me The forgoing instrument was acknowledged before me
this day of 20by this day of ,20 by
CC.. Le—e— Le..-1-D w r.,L.A,..._.
(Na' e of person acknowledging) (Na A of person acknowledging)
( A I,, ii, t ki./Ay
Si na ure of Notary''ublic-State of Florida ) :ignture of Notary Public Sate of Florida ) \.,_,
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificat'on Type of Identification
Produced 01_ Produced
^, ._ -- -.•^� — — iP,IiVA INGRAM
Commission No. er✓`- �,(Seal')NA INGRAM Commission No. (Seal)
�•, 10rtda a ����µYr.ei� ilo.. '�,,!e-State of Flom j
� �n°. Palle ; riia
�,� 2`1E
_,=o* ¢* P�otafTm �,:oites Dec 2G,2G1811; •.! y Comm.-•'Fii, ,„:2.7
Y rj, P;1
,N* i oma_ Commle�rcn FF 1772 sy (I�m�s c Coy ir,is::. ,utary 1 sr\•?
REVIEWS FR fN'24;;o�`,,,LC°trough�\ISUPER ISOOR' PLANS VEGETATION SEAfTURTLE'� d f°./IANGROVE
COUNT_E"���� ; --VIEW'::—-'-''REVIEW REVIEW REVIEW REVIEW REVIEW
a;
DATE
RECEIVED
DATE -
COMPLETED
'iev. 7/2014