HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE CCEPTED
Date: Permit Number: �$� l• ®01 '1
v�" 1
Building Per it Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PR' POSfD INPROVf(111ENT LOCA1'IN:
Address. (�60 (D 2C w S
Legal Description: c) 110 0 a4 L),In
Property Tax ID#: �2 -70 > b 6 no Lot No.
Site Plan Name: Block No.
Project Name: V < < ff 0
Setbacks Front Back: Right Side: Left Side:
D T'AI�LED DE�SC +I�PTfON �F WORK:
C0 STRUCTIO IiNf-ORMATION:
itiona,wor Fo be pertormed under this permit-check all that pp y:
_Mechanical '' Gas Tank Gas Piping Shutters: Windows/Doors
Electric P robing _Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: rte- Sq. Ft. o First Floor:. _
Cost of Construction: $ '61) !�7 , u 0 Utilities: —Sewer _Septic Building Height:
NER/LE�S�SE CON RAC�TOR,
Name H Ccv`L` /)eO O � - Name: PP V)Y)O
Address: D V— Company: �t��'"�LY��Uiz. Z"> t.'
City: n ` State: '�L Addre : 1-7 �� t`g.e " f'.L(3 /N
Zip Code: IY�4(ec� Fax: City: State:-12�-
Phone No. 9 Zip Co e: YSfs�/ Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State r County License 1
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S PPIEMENl'AL CANS RIICTICIN I( LAW FAR 0 I •N.
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 strut res,swi ing pools,fences,walls,signs,screen rooms and accessory uses t n er non-residential use
WARNING O' N :Your failure to Record a Notice of Commencement may es in your paying twice for
improvem is o y r property. A Notice of Commencement must be rec d and posted on the jobsite
before th it ins e,�tion. If you intend to obtain financing, consult wit en r or an attorney before
commen n or af`r ,cordingo Notice of Commencement.
Signatu f ner/Lessee/Cg t ctor as Agent for Owner Signature of ra Lic nse Holder
STAT OF FLORIDA � STATE O F OR�,
COU TY OF ,htaC,.A, COUNTY OF
Theforgoing instru ent was acknowledged before me The forgoing instr ent was acknowledg d before me
this W day of 20� �by this day of 20a by
�1
(Name of person acknowledging) (Name of person acknowledging.)
(Signature of Notary Public-State of rida ) (Signature o TNotary Public-' State of Flo a) \,
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced --'
LA51IAhINA INGRAIN
Commission No. `,mss aY,�a.; Notai(;SeaJ);c State of Florida Commission No. r�Seal)1`AtN of ptorida
Static 8
;� *•=My Comm.Expires Dec 20,2016 pup�tc 2p 201
=,* * fission 0 FF 177249 ;totary m ExPttes OGS 77249
t "%rE of a°.�.� 1 :i i c ¢ tv
���,,,, •• Bonded throug t National Notary Assn.i� *�- Comm sstort�Ctonaootat
REVIEWS FRO,N . = a tN#NG �°" SIPERVhSOR PLANS VEGETATIO dth'n�M_ANGR"OVE
COUNTER REVIEW REVIEW REVIEW REVIEW ''% fl3VU�/ REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. /2014
Planning& Development Services
rys.'a' Y r. NiR� .IVI � 4` •
�., y' Building&Co a Regulation Division
2300 Virginia venue
Fort Pierce, FL 34982
772-462-2165 r 772-462-2172
Fax: 772-462- 443
ROOF INSPECTION AFFIDAVIT
Re: Permit# S L C &-O — 09>-
I,
Aicensed as a(n)Contractor*/Enginee Architect
(Pleas 4 rint name&circle license type) ."FS468 Building Inspector
*General,Building,Residential or Roofing Contractor or any individual certified inder468F.S.to make such an inspection.
On or about X14 1 did personally inspe t the roof deck nailing
(Date)
work at: D ,,�'G'�p G!� ��ti`" `,- _
(Job site address)
Based upon that examination I have determined the installation was done according to the current
edition of the FI rida Existing Building Code Section 708 or the product approval submitted (whichever
is most
'gnature and Seal License#
STATE OF FLORIDA
COUNTY OF
Swor to and subscribed before me this day of 200
by P Who is personally knolln to Oe or who has produced
as identification.
Notary Public,State of FI ida
Signature of Notary:
Commission Number: (Seal)v LASHAHNA INGRAM
.."aYA
En `=o� 4 •; Notary Public State of Florida
4 * My Comm:Expires Dec 20,2018
Commission#FF 177249
%;OF
;°�° Bonded Ihronph Nat►onal Nott!Also.