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HomeMy WebLinkAboutBuilding Permit Application I I I ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE CCEPTED it ate: P rmit Number: Building Permit App ication 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 Residentialy PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line .mak.. ,.R. r'_ (�«_ Address: ?�,99 ANS P�IP -� C ' �L 3�tq L- egal Description: LA4V �I,CIL- t%cc;P�1 l5 P r AD, OJ)L' all ?S— L I d i2 3 5-1 - ;i ropertyTax ID#: �1 �fl ©� © 'rC) Lot No. !Site Plan Name: Block No. Project Name: (Setbacks Front Back: Right Side: Left Side: -uG�' z � 4go- 2.�, f." rr.�°"•� B ;kgs €a .€ " � �� " v t z33«� "k-. 'vm a � ""� "„�°°n Yta",g .�,a: �, �.� - ;: £QETAILED�C3 a .L..<: OV 15- AWP OWL, � t�l S�111Jo1 6�)✓� `L�jOl2, 5�-C.. rHTpry `TPS-e -5 .rC411-D 3- j Y X: . zt,&,_,� {k•, O,i�A -F _ `k'3k"" k8�sF -v1,, �' �y Y'E'1A,� 1 �6,1k 3. itiona wor to e e orme un er t is permit-c ec a a p y: HVAC �Gas Tank Gas Piping _S utters Windows/Doors Electric Plumbing Sprinklers enerator Roof Roof pitch Total Sq. Ft of Construction: S Ft.of First Floor: I Cost of Construction:$ 1 Utilities: —Se er_Septic Building Height: �.,, .',,T�,'s, �����a K..,., ., �,y"�< ,,::.S.S .'hN..!..,s.-.t.s , f.. € .c<: • a .. » vtv.. ain 'hi X4,�� .,+... J£ t..?;"D7'.'`..`u '��� Name FAU.l_ 1} Ch-20 L-- RA-LS TO Al Name: ^ Al A) Address: $r}�& -SAP f(PQL C[/2(' Compa y: oS *A;ID (YItE l)E�—TAN �. City: _Uel�� State:- Addres Kly&9l - 14U?y Zip Code: Fax: city" — ityState:' Q Phone No. 7a-' te'J) - �7 Zip Cod : ? � l gr Fax: �7a"��� `��33 E-Mail: Phone o. `7-7 a- y0q ' 990 Fill in fee simple Title Holder on next page(if different E-Mail: VA r) C rowre-TC x v o from the Owner listed above) - State o County License: CK'' t$31540 If value of construction.is$2500 or more,a RECORDED Notice of Commencement is required. I aq�,Y,ti .��,:.,.. . .. �'j. ,�. .. xe' a.�,�.s��� '� �' >,..^.� _, .,.¢"•i'.'�E.�..,�„`�.�,t�T "�'r* ��.W.�`. .. x«: ss..& ::. .. � a,,.:,'+�.�`-. DESIGNER/ENGINEER: _Not Applicable MORTG GE COMPANY: _Not Applicable � Name: Name: Address: Address: City: State: City: State: Zip: Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: _Not Applicable BONDIN 3 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 permit. St.Lucie County makes no representation that is granting a permit will autho ize the permit holder to build the subject structure which is in conflict with any applicable Home Owners Association rules, byla s or and covenants that may restrict or prohibit such structure.Please consult with your Home Owners Association and review yo r 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, con ult with lender or an attorney before commencing work or recording our Notice of Commencement. I Signature of Owner/Lessee/Contractor as gent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF COON OF The forgoing instru ant was acknowledged before me The forgc ing ins ument was acknowledged before me this L day of 2(A by this L day o 2011 by � . e Name of person making statement Name of person making statement Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produce (Signature of Notary Public-State&Florida) (Signatu-e—of Notary Public-State o lorida) Commission No:' � A(Seal)Jte()I FloridaState of FCommis ion No. (Seal) `u*1�.; Notary Public ices Dec 2 2018 _; * ._My Gornto•Exp F 177249 LASHAHNA INGRAM �Su Nota �N,19t �.ou9h Natic nal " ,* *c ivu iai q b fl�, omr .rypi es Der.20.20 S REVIEWS FF`119JI�VG �SGPERVISOR PLANS VEGETATIO °•" RTL MAN.G.ROVE. i., m iSSMN; i,�49 COUNTER " REVIEW REVIEW REVIEW REVIEWo ,;GfEWndedthbigl E1WW"turyAs n. DATE RECEIVED DATE COMPLETED Rev.8/2/17