HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETLI APPLICATION TO BE ACCEPTED =
Date ! I ` I� Permit Number:
SCANNED
_
- C7O Lua1® C®WAY
RECEIVEb
Building Permit Application
Plannl'ng and Development Services $FP y. 17018
Buildi Jg and Code Regulation Division Permltting DepSCIart
23001 ►rginia Avenue, Fort Pierce FL 34982 St Ling pa nt
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II y
Phon : (772) 462-1553 Fax: (772) 462-1578 Commercial Resident
61
PERM IT APPLICATION FOR;
I�
P USE R lfUP OVEMENT "MR-0:
Address: 18��3 �("Id�P� (00,14 i YA P I ei Lf, Ft, 3y982
Legal Description: L O,N k kon tot &A ,, r S4(;LCIF 1L 0) L o 4 22
III
Prope 'Ii�y
Tax ID #: `�2(I - O 002t-1 - c�Oo - 3 Lot No. 2
Site PI "
n Name: Block No.
Project
'
Front0 Back: qO Right Side: � Left Side:
iName:
Setbacks
ET [V s RUM 01"1T10N
d
ila
CONST UCTIgN 'NFORM 10
AcFditic
ina workto a per orme un er this permit - c ec a tat apply:
_
_ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric
Mechanical
_ Plumbing _ Sprinklers _ Generator Roof �Pitch .
Total S
I,. Ft of Construction: VVA A Sq. Ft. of First Floor:
Cost of
�I
I, onstruction: $ . -100 .Cho Utilities: —Sewer _Septic Building Height: -�
I
QW
' 1MSRNE
IMrs
S.
Name:
Name���
1$OtJ3 f?,Clrl� l/y
Addre{{ls:
Company: '
lil fi I t.�C-L- State: C-1-
Address:
City:
Zip Colde:
g)Wffi Fax:
City: State:
Phonj11No.
(112Q (ol1
Zip Code: Fax:
IAIILYIn1rG(ZZLn22Cn @ -Aiim. en yn
E-Mai
Phone No
lee simple Title Holder on next page (if different
E-Mail
Fill in
from
I
the Owner listed above)
IIJ .
State -or County License
If value
t1f construction is 2500 or more, a RECORDED Notice of Commencement'is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:.
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Name:_
Address:
City:_
Zip:
Phone:
_ Not Applicable
State:
_Not Applicable
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 : Your failure to Record a Notice of Commencement may result in your paying twice for
impro nts to you property. A Notice of Commencement must be recorded and posted on the jobsite
be re the first insp do #-yo en to obtain financing, consult with lender or an attorney before
c mmeKicin r recording your Notice of Commencement.
Signa ` .r f_Qwue essee/Contractor as Agent for Owner
Signature of Contractor/LLicense Holder
•
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOF o
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before Me
thisl day of '��_oDk 20_t& by
this day of 20_ by
(Name of person acknowledging)
(Name of person acknowledging)
atu a oft 146ta y,,P.. blic- Stale of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification -"-,J
Personally Known OR Produced Identification
Type of Identification
Type. of Identification
Produced ASHAH!NI INGRAM
4�c+=;
Produced
Notary Pubf'((c - State of Florida
Commission No. My CO �J,pires Dec 20,
Commission No. (Seal) j
N `= 2018
�• Commissiod # FF 177249
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�i u01p,• ni.,r,,.,.,i n
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEXTURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
,
Rev. 7/2014