HomeMy WebLinkAboutBUILDING PERMIT APPPLICATIONAll APPLICABLE INFO MUST BE COIV'-LlTED FOR APPLICATION TO BE ACCEPTED
Date: 161 % SCANNED Permit Number: 1 (oq "C)3(Q9
St. Lucie County
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 Residential
PERMIT APPLICATION FOR:
Address: W l b 0 3- urefnv\ br C 1v\ 0- 110
Legal Description: Th, !" 11f:LM o f 11 Q VGA- 005
Property Tax ID#: 4o2--7ca6050at70.3 Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No.
_Mechanical _ Gas Tank _ Gas Piping _Shutters —Windows/Doors
_Electric _Plumbing _Sprinklers _Generator
Total Sq. Ft of Construction: 1 ('0C-> 0 � Sq. Ft. of First Floor:
Cost of Construction: $ (S / 0OC3 Utilities: _sewer _Septic
Roof
Building Height:
Pitch
aOWNER/LESSi E:° fr p .,
ae... .. .... x-x. .i":bt.k
GONTRACOR :Ar .} r.
Name f'ir�L -5akomo^
Name:
Address: 901(oQ ,S . C3(:edv\ Nr) 04 110 S
Company:
City:TeyiSCIA 16 4(-Vn , VL State: FL
Zip Code: 3y 15 7 Fax: r�
Phone No. c - �— iS
Address::
S State:_
Zip Code: ^ ^ %
Pktonelo- _•
E-MaiI:PS®S6[G✓�00�rUt?teS•I
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
'MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone
_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 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 inspect�''9u,II� ou intend to obtain financing, consult with lender or an attorney before
commencing work rav rWining vour Notice of Commencement.
Signature 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 instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this -Is— day of p X 20 IDby
"_ C�
this _ day of 20_ by
(Nameof person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- Stat& of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification °
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced F� .�\92F
Produced
SX+SS - 'Z I Ci • -is- • I qX. o
Commission No. (Seal)
Commission No. (Seal)
•^,p � LASHAhNA INGRAM
REVIEWS
F
€i) q(aJ Expir
PLANS
VEGETATION
SEATURTLE
MANGROVE
C tqp
' E lion
r
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. //2614