HomeMy WebLinkAboutBuilding Permit Application Ail APPLICA13LE INFO MUST BE CO V,PLE tTU FOR AI9RllCATIf7N Ti)BE ACCLP`�C �d
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Date: _ Permit Number:.
RECEIVED
Building Permit Application OCT 0:2 2017
Planning and Development Services aPERMITTING
Building and Code Regulation Division
St. Lucie County, rL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential I
PERMIT APPI ICATION FOR: -� 111A 02�-/Q0S/
Address: ]03 IN QL?V Phly" `
� SOTIq `o ' V`-Fj�ibLegal Description: P � /
FTOPS $02- V FTQF1,0rz-11NGCo-Ph
L/N 30o /'r" Wor ANDllm tn/ &�&L//1/Fof-s lgf)-/-e S Rplllti—w1piPRTs(ZoA�x3576`
Property Tax ID#: 931 /C)00 !�OOZ Lot No.
Site Plan Name: Block No.
Project Name:-1112/CeflzlPE/)'I �111�5 cF M�Zf� N/C/�2 1-}CG 'SS
tI Setbacks Front Back: Right Side: Left Side:'
sy4
-
61 D�
m N.AN ICE GG &55 St41k 5, NURR/CAN F STPH5 Mom RA iF16R S -rc
WALL
Additional work to be pe rmed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters VWindows/Doors .
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: �0 Sq. Ft. of First Floor: 1
Cost of Construction: $ 232, Utilities: _Sewer i/Septic Building Height: Z �
Name-F/A4 Pe 90S/&?e Name: iL� f4f `�5Y,I
Address: S(03 IIUa11W R/1�� ��. Company: �tE FI015HOJ6, + ON xL-kC
city: FT P1 a(C- FL State:�L Addressc ��as^ MA-0jW. CAuA PLC
Zip Code: Fax: City: Stater
Phone No. :272 ()2-6. 7 y-9 9 Zip Code:- 3NRy3 Fax:
E-Mail:_ im !JCLI�A&I 05wa.11.aw Phone No 777P ` 19 5311-
Fill in fee simple Title Holder on next page(if different E-Mail ` K_F FtjjoSrittvGR'kk14 G-MA I(v•Ccrn'I
from the Owner listed above) State or County License 113
If value of construction is 2500 or more,a RECORDED Notice of Commencement 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 per 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
commencingwork or recording our Notice of Commencement.
Sign re of ner/Lessee/Contractor as Agent for Owner n re of ntractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S 1 � COUNTY OF ZA s>_
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this TI-_day of 2011_ by this.L_day of ,20_. by
Nam6WWo_n9naking statement. Name 3W69M m ing statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification`
Type of Identifica ' n Type of Identification
Produced v� Produced Ih.
Qo WlikpNso L_
(kig. urlrof Notary Public-Sta of Florida) (Sig re f Notary Public-Stat f Florida)
Commission No. (Seal) Commission' -• a
LASHAHNA INGRAM .s`p'a"r'p�e., LASHAHNA INGRAM
4 i�n a 1uv '� ...._.•_ nx �' .� y u
' f v `mmVVEr:sires Dec 20 2016 R9y ,omm. b:rlres Dec 2 9D18
REVIEWS FR ICI �ZOI 1� ���i; ; �SUP�RV)SOR' PLANSE� CtN ,cSEA;TURTL-E177,,,MANGROVE
COU:VTfR ,;;;. REVIEW,; ✓ REVIEW REVIEWR��IEV19 e ^ REVIEW,..,ro a yAs IEW
DATE •�_. : _ ..-�-:,
RECEIVED
DATE
COMPLETED
Rev.