HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE Czi.c:PLETED FOR APPLICATION TO BE ACCEI'i.,J
Date
Planning and Development Services
Building and Code Regulation Division.
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: (P 10
V,gANNED
BY
at Lucie GOWN,
Permit Number: r 66
Building Permit Application
Commercial Residential
I
Legal Description: U Y1, 1 10 166e- 33 � IJ � Lo- a4
Property Tax ID #: 1301 " &/z - 03(Do . 000
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
nai wo
_Mechanical
RECEM
FEE 0 6 201E
lwewf�14 weft
'ik.4,,
Lot No.�_
Block No. 3 3
pertormed under -this permit - cnecK aii tnat.appiy:
Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator Roof nn Pitch
Total Sq. Ft of Construction: �? 5 6 S f Sq. Ft. of First Floor:
Cost of Construction: $ I �C, -w Utilities: _ Sewer _ Septic Building Height:
Name W1 lI e V L AvS'Oh T►e. Name:
Address: O Company:
City: F-4 • f C-4- State: fie, Address:
Zip Code: 3`i q 5 ( Fax: City:
Phone No. 1 1 2 -$G1-% 7S Zip Code:
E-Mail: snod k 1G1dI. C 1 c0 4 Kka-:,( �: Phone No
Fill in fee simple Title Holder on next page ( if differe'nts E-Mail
from the Owner listed above) ''State or County Lice
Fax:
State:
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPI.EMENi'A CONSTRUCTION l.1EN SAW INFC�RMATI�I.
DESIGNER/ENGINEER: _ Not Applicable :.MORTGAGE
COMPANY: _ Not Applicable
Name:
Name:
Address: ;.
Address:.'
City: State:
City State:
Zip: Phone
I
Zip: Phone:
FEE SIMPLE -TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: I Zip: Phone:
I
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 Ito 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 Corrt;mencement 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 o caner/ Lessee/Contr ct r as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF If. k �,r= -
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this ( day of F'e Po 20 Cam? by
this day of 20_ by
(Name of person ackno edging
(Name of person acknowledging)
4naiture
of Notary Public- 54ate of Florida)
(Signature of Notary Public- State of Florida )
Personally Known. OR Produced Identification ti
Personally Known OR Produced Identification
Type of Identification �..
Type of Identification
Produced ,666„ LASHAHNA INGRAM
State of
JFlorlda
Produced
Notary Public
Commission No. IJ.2° ; . My 4��)Expires Dec 20,
2018
Commission No. : (Seal)
Commission # FF 17
249
.
Bonded through National No
nary Assn.
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVI W
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014
i