HomeMy WebLinkAboutBUILDING PERMIT APPLICATION+ I
All APPLICABLE INFO MUST BE 6C7mPLETED FOR APPLICATION TO BE ACCEI
Date: Permit Number:
SCANNED
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Building Permit Application wit
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Planning and Development Services per 5t t� 1 c'ounh'
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:
PRQPtJSEQ:INPROVEMEIU
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Address:
Legal Description: _
Property Tax ID #: a3M
Site Plan Name:
Project Name:
Setbacks Front 363 `
arm t P*yl f-
3aQ 0661 r)0O
Back: 31 Right
L F Po-ev-ems fL 3Yei
Lot No.
Block No.
r Left Side: 2-7 S'_ 1
4 UJ/i&`/u 1&"
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Aaaitionai worK to oe perrormea unaer tnis permit-IcnecK aii tnat apply:
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_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors _ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ J 0 D U
Sq. Ft. of First Floor:
ities: _ Sewer _ Septic
Building Height:
01I1lNER/LESSE
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COivl'RAC'OR.; e
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Name mfelr.<(L ('fr,,.cosw
Name: Inia&W, Difreo r-e50
Address: 2340 �oreior-r P;rr
iCompany: fbvsi `-
Address: IeZyo f�o�,P �e S�+t rh c T
City: fT�r fc 'L. Stater
Zip Code: 3Y6q S' Fax:
' City: PT PCC-, State: -j- L
Phone No. `772 2d1 7'7 17
Zip Code: 'SY'i45— Fax: -1"72 1r,S- 7-9�-3
Phone No 771- %l 77f 7
E-Mail: 1,06t ) It a 401- < ry!j i
Fill in fee simple Title Holder on next page ( if different
E-Mail�i;r�n: COH S l �aL = cv
from the Owner listed above)
State or County License., R8 a9oU 6Z(
If value of construction is 2500 or more. a RECORDED Notice of Commencement is reauired.
hfINTL C�tU�TR�lTI3 LIEN LA:`,FC3R�ATtI�
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:"
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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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 lis granting a permit will authorize the permit holder to build the subject structure
is in Home
which conflict with any applicable 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 work or recor*g your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor License Holder
STATE OF FLOPJDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instr ent was acknowledged before me
this day of k 20 hill by
The forgoing instru ent vvas acknowledged before me
this, day of 20 IY by
lJfl4tMo��/D
(Name of person acknowledging)
(Name of person acknowledging)
(Si re df Notary Public- St a of Florida)
(Signature of Notary Public- St of Florida )
a�
Personally Known . OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced �h�
Produced
" "• LAISHAHNA INGRAM
Commission No.
Commission No. °`;. Not(5eal)flic - State of Florida
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My Comm•. Expires Dec 20, 2018
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t J LASHAHNA INGRAM
Commission # FF 177249
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Expires Dec 20, 201B
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ANGROVEREVIEWS
COUNTER
REVIEW
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DATE
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RECEIVED
"' 13
DATE
COMPLETED
ev. 7/2014