HomeMy WebLinkAboutBUILDING PERMIT APPLICATION� r
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2—q I 0 Permit -Number:
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:
IAddress: "i I 1f5EL-VMy Ill- �
Legal Description: -33 Z% • c>)
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back
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au N St LQ.9r� ►t�Qan� MAR Z'9 E®
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Building Permit Application Pe mill ant
Commercial
- OiJ -y
Right Slide: Left Side:
Residential I/
ti
Lot No._
Block No.
Additional work to be pertormea under tnis permit- �cneck all tnat apply:
Mechanical _ Gas Tank ' _ Gas Piping _ Shutters _ Windows/Doors
v1 Electric _ Plumbing _ Spri klers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ?.1 /+00, 100 Utilities: —Sewer —Septic Building Height:
{3V1l�ER/LESSEE �:I Jill 11,tt3NTRACT®R:
Name ;.4oA4ins L
Name: R40L-
Address:Mo 'r HO Q G O Co z .
Company: GV kL0)1J6 T--lac.Tor_- LLC
City: 5017114 PAM-El State:
Zip Code: 01 I Fax: I
J�S
Phone.No. 41, 33 92 8 ?_8 13
E-Mail:
Fill in fee simple Title Holder on next page ( if differ ent
from the Owner listed above)
Address:2l6 jiUS 'ec.e_t,,szalT 6a?-oyiJ WA
City: �/�r� T S�s L-Uclill State: FL
Zip Code: Fax:
Phone No -56 ( 6 8S SZ S
E-Mail bu i (A ►na ,go cloriJ Gt oo . corr\ .
State or County License CCsG f <z I G 'i Ti
11 If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Ma
S PPI,E -NTAL CQ S�TR�l1�T
DESIGNER/EN(;INEER: _ 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 andcovenants 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 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 _ Q�
.,L��
COUNTY OF S
The f,Qrgoing instrument was acknowledged before me
this day 202_ by
The forgoing instrument was acknowledged before me
day 201% by
of o
QV
this20k- of Mc _rrA-\ ,
(Name of person acknowledging)
N e of pers n ac owledging )
(Si n ture of Notary Pu - State of Florida)
(Signq, re of Notary Public- State of Florida )
Personally Known Pr ce"d. Ide_ntificati nc
d
P rsonally Known OR Pr I� Y �' tificationj
Type of Identification �,,������,,, LASHAHNA INGRAM
'a ate:
Type of Identification _, o �, _ Notary Public -State
Produced •��`PRVP�e�%%': otary Public. ;'State of Florida
Produced 1"1� Z—• "saa oo; My Comm. Expires Ap
S. ; ; My Comm. Expires Dec 20, 2018
"%;;o �� �q�..•' Commission FF 1
Commission No... C(M4sion # FF 177249
Commission No:_,
''�,,�������` Bonded through.National Notary Assn.
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DATE
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DATE
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t g1te,
COMPLETED
ev. 712014
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201E
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