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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONII APPLICABLE INFO, MUST BE COMPLETED Vlc APPLICATION TO BE ACCEPTED Date: r Permit Number: it SCANNED auaA4unpD a-�n� aS BY Eu4jedaQ 6upalu Buil ing ermit Application e1°z�v �►io Planning and Develoliment Services Q3/►13J321 Building and Code Re Iulation Division 2300 Virginia Avenues, IFort Pierce FL 34982 Phone:�(772) 462-1�53 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: dress: '% q d O 111131 0 C ;al Description:.��✓� Property'Tax ID #: Site PlanIName: _ Project Name: Setbacks Front 501 © [ to' r V1, tI(ru, M 1 ti vlet �— D -- � C} 6 — o o b 3 _ 000 — 3 Lot No. L,, e 2 ire Y- Block No. Back: Right Side: Left Side: v i G ) I t G e e ear a e, _ � ©� l'/ IOG,� 1 dal L,,4 C;> Ul a Is011aw Additional work to b pertormed under tnis.permit — cneck aii that apply: _Mechanical _ Gas Tank _ Gas Piping _ Shutters • Windows/Doors _ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch I otal Sq. of Construction: fiction: To Sq. Ft. of First Floor: ost of Construction: $ , O L Utilities: —Sewer —Septic Building Height: OWNIIR/LE�S�5EE: GQNTRACTUR. Name (` b" Address: %y0D �'I� �v� e Zip Code: Phone No. c2 iq E-Mail: I Fill in fee simple Tit from the Owner list � W k eef e -Rv i r/eZ, Name: Tdkri Company: l �• / fUir, itL.,City: Address: ! 3 ou W — aq Y f-A 17 City: , l ri- Ye',nG'G+ C /^- State: Zip Code: �Y 9 S % Fax: �% `n2 % 7 Phone No '7 7a2 5'�2 4 Cg�v. 0�' /�t lli� Ps-C k- State: f-' I % Fax: u S 3 0 I� Holder on next page ( if different d above) E-Mail Jd kn t e b 1.3 G9 Alled State or County License R %r .3 value of, construction is 2500 or more, a RECORDED Notice of Commencement is required. I� SU PLE ENT L CQN^ T �UCTIQN 1- MN LAIN fN;Ft�RMA ION: DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Applicable Name: / ��' c° �, . _Not Name: Address: Address: City: P State: City: State: Zip: Phone 7 %a ,?1:7' 6 Y Y `l Zip:. Phone: I 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 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 commenci#g work or recording our Notice of Commencement. ; Signatu of Owner/ Lessee/Contractor as Agent for Owner Signature f ontractor/License Holder I STATE OF FLORIDA STATE OF FLORIDI COUNTY OF �t,�_, 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 son making statement. Name of Inown Name of p on making statement. rsonall Pey OR Produced Identification �` Personally Known OR Produced Identification Type of Identification Type of Identification Produced Produced (' urk of Notary Public- State of Florida) (S)w4to of Notary Pu lio florida_) v LASHAHNA INGRAM Commission No. (Seal) Commission No. '2�" •�""�21b r'(�ea'I) State of Florida PAy mm. Eepires Dec 20, jl ,�wm„ I_ASHAHNA INGRAM lum idd] , 2018 's"' 6�c gmri;c c FF 177249 lF REVIEWS REVIEWS ��r e� ' a ° FR�ON . •,_ Notary Public . - n Erp c?ONIN� • state rr ^r 8 Sl1FP.E �% b PLANS VEGETATI N + on; e m IV - SEATilRTL"E` ' ,, onal Notary Assn. 'MANGROVE COU�N;1�, REVIEW REVIEW REVIEW REVIEW io°EVW�°i�a#EtIEyWssn DATE aH =�--_ -:: --., RECEIVED , 0 DATE COMPLETED 7_ ev. 8/2/17