The URL can be used to link to this page

Home My WebLink AboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLe ,D FOR APPLICATION TO BE ACCEPTED - Date Permit Number: 10.0/ � ` SCANNED - _ Building Permit Application By Planning and Development Services OR Building and Code Regulation Division ��I�County 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: Address: 47' 7 © S,4 A Di c-- y 7/� il'yE- 17—P j G2�C Ft - Legal Description: f��m&n� T'I�I�I �.�� 109N NO3 91-k ,p � g gy Property Tax ID #: / � / © ��VOL94 Lot No. sib Site Plan Name: Block No. Project Name:d®G Setbacks Front Back: Right Side: Left Side: Windows/Doors Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ Utilities: —Sewer _Septic Building Height: O N SSSEE. CDNT'RA OR: Name � •'�ni7 G �I �`rtA�Q Name:,.... Address: 73O �/+i"hl:o AZW Company: City: AC-,LCjam. f.. - State: Address: Zip Code: �9 �'�'' Fax: City: %U�liS`t�ri� Stater Phone N110. % — ,-� er/ `7 `� Zip Code:' 39-9149 . Fax: E-Mail: ! Phone No Fill in fee simple Title Holder on next page ( if different E-Mail CSi,+Hr-on s- Roc;oNANcf Reoryl ® 6 from the Owner listed above) State or County License CC- G I2 %SQ If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. S PLEEK 00MANICREUSE : LILMNS1 1 1118511lA RM PRINS:. DESIGNER/ENGINEER: _ Not Applicable . MORTGAGE COMPANY: _ Not Applicable Name:. Name: Address: Address: City: State: City: State: Zip:' _ Phone Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Applicable _ Name: _Not Name: Address: Address: City: City: Zip: Phone: : i li 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. Signature of Owner/ Lessee/Contractor.,as gent for Owner .\ Signature of Contractor/License Holde STATE OF FLORIDA STATE OF-FLORIDA COUNTY OF s , COUNTY OF' The forgoing instrument was acknowledged before me The JRrgoing instrument was acknowled before mei this day o 26a by this day of 2 by (Name of person acknowledging) (Name of person acknowledging) �'1MQ Notary 0oricla (Signafurof Notary Public- State 6f Florida) (Signature of Public- State of ) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of Identification' Produced oduced ,``� "LASHAHNA-IINGRAM `^: .�" "��. LASHAHNA INGRAM Pa� "464 *" Nota?u � � -. e' ,ter°, . „`�: Public - State of Flora Commission No. � y t�G mmission No. w . y u ) RAty • •Com. Expires Dec 20, 20 °%'s commission # FF 177299 8 . y C a State �.�` oF' oa`�`'P; omm' 'CXirn. OF Florida oaa,• REVIEWS FRONT Duflueu Ir ZONING MIA Mauorial Notary Msn. SUPEftV150R PLANS x VEGETATION ondedm SEA•TURTLE ;"MANGROVE Il COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED „ .. DATE' ;_ -• O COMPLETED ev.