HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �� d
Date: Permit Number:
a�cF�o
Building Permit ApplicationP Nov°5? o10
Planning and Development Services jL��9 depart
euilding•ond Code Regulation Division a C°4nh,ent
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: 1/060 JV
Legal Description: S^440-& G AeAC
Property Tax ID#: L/ " rd l —a 6/.0 — G>o / Lot No.
Site Plan Name: S ALV4 4� C_A Lel_ Block No.
Project Name: V d6A, R t /WAC'
Setbacks Front Back: Right Side: LeftSide:
i
1Z.L�P�-�-L�s ✓\.,�d9-/� �'h.>`►,l✓ �l�>:Q G-� f.9-�o�
Additional wor to be pe orme un er t rs permit=c ec all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _1/ Windows/Doors
ElectriL _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
.Cost of Construction:$ X06,m p Utilities: —Sewer —Septic Building Height:
Name J c,,.,,.,`=i;� L sli v Name: 104-�n is Lv
Address: //®aU 7;"i.v,b��/"�/af Company: <--L i.?- 5*�D�e¢T/6.v
City: 10av1-5i State:_ Address: 1/ 9 iV"14,
Zip Code: Fax: City: /tee r T :�?— L ci e,it State:/9(--
Phone
LPhone No. Zip'Code: 9 `t99:9 Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail h
from the Owner listed above) State or County License
m
If value of construction is 2500 or more,a RECORDED Notice of Co
mencement is required.
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
11 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 OF COUNTY OF
The forgoing'instrument was acknowledged before me The forgoing instrumen was acknowledged before me
this�day of 204 by this 'E�day of 201'R by
(Name of person acknowledging), (Name of person acknowledging)
(Signat of otary Public-State of Flo ida) (Signature of Notary Public-State Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification -4
Type of Identiifilption Type of Identificatiann
Produced -,Produced
."tov ptl LASHAHNA.INGRAM
Commission No. ?=°m «`� Ngg )jblic-state of Florida commission No. (Seal)
.•. ;•`My omni.Expires Dec 20,201 •,,,,u,,, LAS ANNA INGRAM
"� °`= Commission#FF.177249 -%'a `Y P��%.; Notary Public-State of Florida
9 4.�
one r uo a uua d� _ *. y o ,
-,N° m I� #FF 177249 r
REVIEWS FRONT ' ZO MP R�SOR PLANS VEGETATIO ., ` RTL° , GR A,Ass _(
ndedth
COUNTER REVIEW REVIEW REVIEW (REVIEW EVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.