HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED II
Date: A -1-1- IC1 Permit Number: 11Q9 ( �
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION:
RECWED
Flu. Is 1n
permitting Department
St. Lucie County
Residential ✓
Address: 3100 TCORIL &\)d , F+ ?IUQ . , FL- 30QU
Property TaxID4A W37-Motlgociorb
Site Plan Name:` ,
Project Name: C
2ncluse. G�Ae,
CONSTRUCTION INFORMATION:
Additional workto be performed underthis permit -check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters ✓Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ y3 ` oa Utilities: _Sewer _Septic Building Height:
OWNERS(AWN��p�
Name LKv-
L + , 6� u 4 AA"5 Name:
Address: 3IUO TfoPfC, LIVA Company:
City: FE ,`euecL— State: R- Address:
Zip Code: 3YW(0 Fax:S`!V)4oG`0'70 City: State:_
Phone No.SJ'7 Z-2 `J'L J-& 323 Zip Code: Fax:
E-Mail llrf r-eSC41Pr0?-0--& i IGi I A) rei Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License
If value of construction is $2500 or more, a RECORDED Notice of ComrPencement is required
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencefnent is required.
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7
UPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to 0o the worK ano mstauanon as InO¢aLeu.
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
.iii nWA W Ar nourV Rrvnor RrrnDnrMG YOUR NOTICE OF COMMENCEMENT."
WIT" Ivain a.L.... a+
v
Sig of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instry� entt w is acknowledge before me
The forgoing instrument was acknowledged before me
this day of f aA.11j � 2A2 by
this _ day of 20_ by
^
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
Produced
Produced
W na ure of N
(Signature of Notary Public- State of Florida )
,, LASHAHNAINGRAM-RAHMING
(Seal)
Commission No
, MISSIdk*§b275050
Commission No.
'�•• +a EXPIRES: Decembeft 2022
FRONT
ZONING
REVIEWS
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
:Fe-v.