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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION71 s � ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED' i D' te: 0 O t p SCANNED Permit Number: 1 0 0 0 'Cns o BY • St. Lucie COMP 191 Building Permit Application JUN 27 ,,dmY pt PI nning and Development Services permitting D Count B ilding and Code Regulation Division St. Lucie 2 00 Virginia Avenue, Fort Pierce FL 34982 Ph11 one: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_ W P RMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Pf,IOPOSED IMPROVE MENT�LOCATION ,,.: . Adiress: `-)d o I . eLy- .18 r►' A&e, � � lr % �Ci , ✓� � 2- U G� 'lO e- /rZ6 Legal Description: S L; r, v, �^ �h 0 A S If 0f T4 404 J) ? I Pro ertyTaxlD#: 060_�- D U of (-6,clo— / Lot No. 'Sit: Plan Name: Block No. Project Name: Se�backs Front Back: Right Side: Left Side: D :f .AILED DESCRIPTION OF WORK:. C u� l' _ OS YlaL�sti CONSTRUCTION INFORMATION: Additional worK to b rtormed under this Permit— check all apply: [1HVAC Gas Tank []Gas Piping _ Shutters ❑ Windows/Doors LL_I Electric ❑ Plumbing sprinklers ❑Generator Roof Roof pitch Tot I Sq. Ft of Construction: v! 02 S . Ft. of First Floor: �v Co I� of Construction: $ ��(1!/t/. Utilities: OSewer ❑Septic Building Height: O„ NER/LESSEE:. ... CONTRACTOR: r I Narjie Address: city: Zip I Phc E-Mail: Fill )4 u w� D f r i' Name: 2 2 vt Company: P0 %e t& Address: ( t/ l= V $! c F G C) v i 6i U) /Vi a r A A i (el, n l u cl: c State:„ Code: 3 I�.� b Fax: ne No. '? of % a A Ll fY 7 City: a r fs�r• h f State: ' Zip Code: 3 z� �*6, 3 Fax: Phone No. '% 7aL— �d Y— 0 E-Mail: %L 40c) � h j 0 1 A C (ate 'Gu fee simple Title Holder on next page ( if different frog the Owner listed above) State or County License: G CC 13 3 If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. 1 UPPL�EMEN.TALCONSTRUCTI:ON•:UtNI LAW.INFORMATION: .. . 1 .,. DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable .11 Name: _ Name: Pddress: Address: City: State: City: State: ip: Phone Zip: Phone: EE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable ame: Name: Address: Address: City: ity: ip: Phone: Zip: Phone: OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated. I' ertify that no work or installation has commenced prior to the issuance of a permit. S w . Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure iich 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. Tf ie 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 ANARNING 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 'rst before the inspection. If you intepid to obtain financing, cons with lender or an attorney before c o W mmen In ork or r ordi our otice of Commencement. h $ignatu Owner/ L se /Contractor as Agent for Owner Sig re Contractor/ c nse Holder (STATE OF FLORIDA STATE OF FLORIDA OUNTY OF e COUNTY OF Sk �o . he for oing instrument was acknowledged before me by The forgoing instrument was acknowledged before me this )A, day of 20 1 It by his day of 2011 l 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 i roduced Produced ltwdnat6 of Notary Public- S e of Florida) (Signature of Notary Public- StRe of Florida ) Commission No. �_ �.� (Seal) ��� LASHAHNA INGRAM << d r ommission No. 1— ;•„ „. ----=i=(Seal)_ ,,.- ; s�P e;- LASHAHNA INGRAM �: Notary .� eo Notary Public - Stale of Florida , _ Public - SYate of Florida =; °� My n Comm Fyni�o n-_ ;REVIEWS ;• a FROM ''%;�01 , • any uomm Q. f iVING d �hrcug rxpires uec u, c ���rq PER ISOf s LANS Jnp �,9 �.�: OF F40 `� ��'' VEG Commission # � . n1fURTI,F3tiona�i F 1772 o �� R©VE �iCOUNT a ilk .: RIEvZrEVIEW REVIEWt fE. 5�`J1/ 4ATE RECEIVED ATE COMPLETED Rev. 8/2/17