HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI
All APPLICABLE INFO MUST BE COMPLETED FOR
PPLICATION TO BE ACCEPTED
Date:
Permit Number:
3
_
Building
Permit Application ,. ,
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Planning and Development Services
!� %q90
A'oC"Nt'
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Commercial Residential 1/
PERMIT APPLICATION FOR:
PRO'Pt3SED IN ' ROUEMENT LOCATtQ
Address:
Legal Description: Ld-r N b%IJLW 9 GZclrenS COVE rihSJ
Property Tax ID #: I Ll )q %D ) 0 0.9LI 00" o $ Lot No. N
Site Plan Name: (01i ,,�; T Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAI'fi.ED DE�S�RI�PTfON OF V�/ORK:
F�dvnJ L .PY75 4c 6GL,,rAQq 4o g-,el~..A Sewi'a!, 0- 13,,4-f-, IZmoYn
d
i
CONSTRUCTION INFC?RM TION:
Additionalwor tobeperformed under this permit- checkch6ck all that apply:
Mechanical Tank Gas Piping Shutters _ Windows/Doors
--Gas _
✓Electric Plumbing Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ "� o S Utilities: —Sewer _,Septic Building Height:
I
OWNER/LEMS�SE :
CQNTRA � R:
Name: ,L,
Name PA-v,•j
Address: S�)- So'Ve r cF Sb way
Company: C, _;h o 6vi
City: (2-1- !P.•e rc c State: f l
Address: 2,24v sevrvr ti� �- i7.�
Zip Code: 3y 9 8--- Fax:
City: (-r State: (- L
Phone No.
Zip Code: Fax: -7)2 %4- 7973
E-Mail:
Phone No 772- ao� 779'7
Fill in fee simple Title Holder on next page ( if
different
E-Mail_ p eo kn
State or County License qa Agau 3G2/
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED
Notice of Commencement is required.
F.M. L M ENTA *ON� INN LIEN LAW I""IR,METIR
SIM
l!GNER —F l�Gl•Npt11Et.F 6, _ Not Applicable r ,
Emp
MORTGAGE COMPANY: Not Applicable
I•� r��. ,_.
�fis:
_
'Name:
Adrd 1t `t
Address:
City: State: 1 `'
City`: State:
Zip: ;Phone
Zip: Phone:
FEE SIMPLE TITLE .HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:s -"
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 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 recording our Notice of Commencement.
Signa r of owner/ Lessee/Contractor as Agent for Owner
Sig ature of Contractor icense Holder
STATE OF FLORIDA
COUNTY OF•y
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20_ by
this day of 20. by
Name of person making statement.
Name of person making statement.
V
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
`1
��� nunie AM
(Signatu a of Notary Public.5tate�o ,Florida,)-�
,�,��u., LASHAHNA INGRAM
gl^aY A�B'�i�
Commission No. :moo, ¢�s Nr(ge�ublic State of Florida
. ; •= My Comm. Expires Dec 20, 201
commission # FF 177249
(Signature of Nota t Pui�1r""fit oq or�e{a• }State of Florida s
�20�4 �o-s �11uta v
- e • 5 My Camm. Expires Dec 20, 2018
ommission No. =° ° a Q: F 177249
Commis: Se�`I '
Foeo-`•a` BondedthroughNational Notary Assn.
REVIEWS
FROM
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PLANS
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Rev. 8/2/17