HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED. (�
Date: 5 1 Permit Number:
n 611101111
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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 '
Address: -7 q 02 uN&_;Z:J ►dAAAR- AIAL )C Sew''e �-
Legal Description: L"P)E2kJQ6p_ AT{�=�,cN;- 3
3 Lie, r7 L-ot7� 664A0 11)+4��
�SS ' 7-S 4 V 89 3 � I
Property Tax ID#: )3p\ loo3 -- 000 ^ ocb Lot No.
-Site Plan Name: Block No.
Project Name:
Setbacks Front, Back: Right Side: Left Side:
R
Additional work to be nertormed under this permit—check a app y:
11HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 3, Utilities; L_ISewerSeptic Building Height:
a N CWill
Name eVtu %&A'GA 1,S4 Name:
Address: 1704 5*Am 'c T- I Company:
City: State:EL Address:
Zip Code: -349gg Fax: City: State:
Phone No.-7) 5 ^2 6 Zip Code: Fax:
E-Mail: i Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
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: Y- Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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
commencing w_oLk-o4:..rqcording your Notice of Commencement.
s
ature of Owner/Les a /Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF TATE OF FLORIDA
COUNTY OF FLORIDA.,���; ,. COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thiscday of 20 0—by this day of 20 by
(Name of person acknowledging) (Name of person acknowledging)
(S atu a of Notary Public-Sike of Florida) (Signature of Notary Public-State of Florida )
Yr94QO--1C10 .;3.3pp•0
Personally Known OR Produced III den'ficatio sonally Known OR Produced Identification
Type of Identification Prod `e. iAsHAHNA INGRAM T e of Identification Produced
�qY PU�i
r2o`; � s Notary Public-State of Flor da
Commission No. '_ * ®I�rnm.Expires Dec 20, 01ro mission No. (Seal)
Commission#FF 17724
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%ISFF�°�° ional Notaryssn.
Revised 07/15/2014 '
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE � jd
COMPLETE J o
INITIALS