HomeMy WebLinkAboutbuilding permit ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: III Q,
Building Permit 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: To Select from dropbox, click arrow at the end of line
PRgO`PO;SED INIPRQVEIVIEIVT LQCATION:o
Address: LAo15- N U3 H I�&t)m _L
Legal Description: 1 '34 46 Pf"W"T OF .S '1 F SW 1/—,q of MN ilG
`/G L1Q- ` q I' )
Property Tax,ID#: 1 '491-o133-C=-QM- c2 Lot No. Is
aw-rlrsl Cove_ Mob')
Site Plan Name: I e Home -?kr Jr, Block No.
Project Name:
1Setbacks Front- Back: Right Side: Left Side:
DETAILED DESCRIPTION°OF WORK
Canverdin �rorn werhe -k3 un e-k-r .=ns I D-ades_ �.
CObNSTRUCTIONINFORIVIATION
Additional work to be nertormed under this permit-check a appy:
HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors
i
Electric ❑Plumbing Sprinklers 1:1Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 15C Q O UtilitiesSewer 0Septic Building Height:
OU1/NER%L'ESSEE =CONTRACTOR:
Name L-LL. Name: -banes Il('1I-Eldo--
Address: - L5 N\/P-- ajP_ �bj Company: MQ+LLJC1 1L-"lec+ric.,
City: 41•uar-� State: fL• Address: 1010-0 ' &A3a�/ IZd .
Zip Code•3y 99 y — Fax: City: r .Ti ler State:F)
Phone No.. Zip Code: 'b4c o2 Fax: I-4(o$5
E-Mail: Phone No.JrJd_- 4).
Fill in fee simple Title Holder on next page(if different E-Mail: niVw',YYVA acpobl.cors)
from the Owner listed above) State or County License: ectIbcol(A3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUCTIONALIEN LAW INFORMATION:
w. _. .
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 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
Icommencing work or recording our Notice of Commencement.
I
M
Sig azure\of`caner/Lessee on tactor as Agent for Owner Signa r of Contractor/Licens Holder
STATE FLORIDAF� STATE OF ORIDA
COUNTY OF COUNTY OF Sa o
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of Zp� ;201$ by this `L day ofZQ 20AL by
Name�ppesonaking statement Name of person making statement
Personally Known OR Produced Identification 3 Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
I
I
(Signature of Notary Public-State o Florida) (Signature of Notary Public-State f Florida)
:_� 1
-�'Sea Commission No. "'
Commission No. (- I Seal
LASHAHN. INGRAM rr R'��,�, .. ')IAiNA INGRAM
I�Ypy9'-, _2�¢ °��;. Notary Public-State of Florid
,��: Notary Public-State of Florida �,
I = ti = F l:.(x My Comm.Expires Dec 20,20 S
- - Comm.-x fires Dec 20,20'18 —, _ A
commission.5 FF 177249
Comml. y; o-
in ?I Notar As n.
REVIEWS FRCIIVT„u`O dtho
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COUNTER::--c>R'EV ``�7 RfVIEW`' REVIEW REVIEW '_,`REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17