HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
ALL APPLICABLE INFO MUST BE COMPLETED FOR AwNLICATION TO BE ACCEPTED r 3
Date: I, / 3 ( g Permit Number:
-- — - �l Luclkll
Building Permit Application pe,�� f 1-0 0�®
Planning and Development Services §" ,
Building and Code Regulation Division �
ent
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential��� 9eHer
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line , , /I -, I
PROPOSED IMPROV
Address:
Legal Description:
Property Tax ID #: v
Site Plan Name: 77UhPS5e j'-6x i C.
Project Name:
Setbacks Front , ack: - = ight Side.
Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
Ittsi'Jeou- - (33C33 10 -6b3v
CONSTRUCTION INFORMATION: /
1AUUM19ndl wvrK Lo oe eHUMMu unaer Lnis Ncr1niL—U1ULr au LaNpry:
I
H frplumbin
Tank Gas Piping I _Shutters Windows/Doors
Electric - F]Sprinklers I Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ 00a Utilities: Sewer _ Septic Building Height:
OWNE L SSEE:
CONTRAC
Na e i 1I S
me: & �
Address:
Company:
Address 1 / t ���
City: State•
_
Zip Code: Fax
City: f!Stat
Phone No.� 70" 3 3 D
�-
Zip Code: cs.-?—Fax:
r
E-Mail: D.
oone No.
Fill in f imple Title Holder on next —Page(( if different
E-Mail: �S/' i .
from the Owner listed above)
State or County Lic se:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
—ti
�4
SUPPLEMENTAL CONSTRUCTt:ONLlEN LAW INFORNIATlON e
W ,.. .
DESIGNER/E GINEER: _ Not Applicable
MORTGAGE COMPANY: Applicable
Name: /�
_Not
Name:
Address:
Address:
City:`U State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPt.E TITLE HOLD�R: Not Ap bl'e BONDING COMPANY: Not Applicable
Name• J 7 Name:
Address: i Address:
19
City. City:
Zip: t 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 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
i e—rn is ur pr perty. A Notice of Commencement must be recorded and posted on the jobsite
efore the first ins ctio . If you intend to obtain financi ,consult • h lender or an attorney before
ommencin wo re din our Notice of Comme ement.
I
e of Owner/ Lessee/Contractor gent
-Signature of Con ractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF !Zk*
iY OF I
The forgoing Instrument was acknowledged before me
this day of 2011 by
The forgoing instr ent was acknowledged_before me
this 13 day of 2U by
LQO,...
Name of person making statement
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced_
Produced L QAy
(S! A of Notary Public- StateV Florida)
Commission No. .��i�u Pal)AHNA INGRAM
(Signature of N
Commission NNotary
ate-,o -Flor=id
,,,OM•. LASHAHNA I GRAM
I" PaY r�s % �
Public Florida
E).pirf s ec�20, 2018
e o,
Notary Public -State of Florida
=• ; ; •E My Comm. Expires Dec 20,
2018
_ = mm.
' K + °-
=;f" t¢o`a Commiss+u # FF 1772 3
',;rF oa,.
ni
Bondpl , 39.
REVIEWS
�oF
FRONTzg�SZQtP"�':
°` throu+
--.,
h N:, �n,! Nctary
SLyPERVISOR
Assn
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
I