HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST E', _JMPLETED FOR APPLICATION TO BE ACC %TD
Date: N'�O— f � Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Legal Description:
SCANNED
BY
St. Luce Count(, RECEIVED
Building Permit Applicatio
% 3.0 1015
PERMITTING
I. Lugie County, FL
Commercial Residentlal
Property Tax ID #: !11 -N 1' W10 -0-))' 1'
Site Plan Name: ��t) I Rn(rt,( STbe d -IV
P
Project Name: LAM) t'I, V ('V ct.y(n VtCA11 rn5vu� �
Setbacks Front Back: Right Side: Left Side:
_Mechanical _Gas Tank _Gas Piping
- Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ q J ,(o—
au trot appry:
_ Shutters
_ Generator
Sq. Ft. of First Floor: _
Utilities: _Sewer _Septic
Lot No.
Block No.
Windows/Doors
Roof
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ,.. LoVf (0.U(� U
Name `' -
W f`
1
'Addressc "J06o1 1�. Qt /�SvlrM k
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a. ,
IGompany:; o
_City•-�K�Uwr(1'�I_� Stater
Zip Code: *� Fax:
Phone No. ', 1 - �� �' 75��
f
•;Address _ m
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�City�N "`�0. W�,V - -'I' p State:
Zip Code: )4JG Fax:
Phone No�18q
E-Mail: �&.asSyrY � lt3o,w, l
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail �(
i
p t'tt(,0 Fi�la�x
tq.CuA4 ,
State or County License
\ CCOS(c aZ1 C a9 Y�
If value of construction is 2500 or more, a RECORDED Notice of.Commencement is required.
SUPPLEMENTAL CONSTRUGT10 -N LAW INFORMATION:
DESIGNER/E GfNE,µER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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
commencing yvork or recording your Notice of Commencement.
Signature
Signature of
Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF�ur.od COUNTY OF_,
The f rg ling instrument was acknowledged before me
th day of Ck �a 2A by
(Name of persl acknowledging)
\(Sijturelof Notary Public- Stall4of Florida )
Personally Known OR Produced Identification
Type of Identification ,
Produced
;r�.>w�%„'a�,, LASHAHNAINGRAM
Notar P is - State of Florida
Commission No. . • (meg�
•,v My Co m. hires Dec 20, 2018
.<<<•y,�•° Commission # FF 177249
ron�V taryAfair.
REVIEWS FRONT ZONING S
COUNTER REVIEW REVIEW
COMPLETED
The forgoing in ment was acknowledged before me
thist day os u20 W by
(Name of perso cknowledging )
Notary Public- State of Florida)
Personally Known OR Produced Identification
Type of Identification —.1116-AWAII.All
Produced ,ota��L„.,� LASHAHNA'INGRAM
r ,• Lary Public'- State of Florb
�: • 5 My�° m Ezplres Dec 20, 2C
Commission No. =r' or B'd 11sion N FF 177249
.... Bonded through National KlUry As
PLANS VEGETATION
REVIEW REVIEW
SEATURTLE I MANGROVE
REVIEW REVIEW
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