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HomeMy WebLinkAboutBUILDING PERMIT APPLICATION (2)All APPLICAB IN O MUST BE CumPLETED FOR APPLICATION TO BE ACCEPT tU Date: I'v SCANNED Permit Number: f,1) q •O3C0� BY St. Lucie Countv 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: Building Permit Application Commercial t, Residential ,PRr)P0r.FI) INPRC)VFMFNT 10177ATInN I Address: 77-(f��/�/`�� c:°4" `= v/^v7 p��� d-� dNO��✓✓� •L��%ls' Legal Description: �� f 2' MIJIN She 5 N�N94� VI �MPV 1 ' 1 4W A:ICC 1C c�f ST i'2,p /k l/+ �/ U O�y g6S.(� &r 6 a)T- Lod -,3 ; N ?� Property Tax ID #: O Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: JDETAILED DESCRIPTION OF WORK: c 1/,5/4/4 779f Sumer DEI,5lIvV 6TEOWZ —s o Gr11�4t1-1/A- CONSTRLICTION'INFORNIATION: AaartionalworKtOrieperformea under this permit-c i%c all tat apply: _Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors Pglectric _ Plumbing _Sprinklers _ Generator _ Roof Pitch Total Sq. Ft of Construction: Cost of Construction: $ 5, Sq. Ft. of First Floor: Utilities: _Sewer _Septic Building Height: .6WNER/LESSEE; . . . CONTRAST R '. Name ' AJI N Name: 0S Address: (7 2• Company: ©l 'r C - City: �1 Ew pl State: 4iRh Zip Code: Fax: Phone No. Address: ZD A'U �I City: N�/�Gc State:_ Zip Code: G /& Fax: Phone No E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E-Mail CO State or County License - e0 If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. 'SO PPLl dMENTiWc6,NsT- IUn6 LIEN LAW DESIGNER/ENGINEER: _ Not Applicable Name: IiVFJ kMA' ION';": ,: � " MORTGAGE COMPANY: Name: r , _ Not Applicable Address: Address: . City: State: Zip: Phone City: Zip: Phone: State: FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: BONDING COMPANY: Name: _Not Applicable 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 work;6lrecording vour Notice of Commencement. , on Signature f ner/ Lessee/Contractor as Agent for Owner Signat e f ntractor/License Holder STAT OF LORIDA ST OF FLORIDA COU OFr �o . COUNTYOF The forgoing instrument was acknowledged before me this ```rr day of "Qe o20� by The for oing instr ment was acknowledged before me this 14 day of P 20-] by (Name df person acknowledging) (Name of person a mowledging ) � Signature of Notary Public -State of Florida) (Signature of Notary Public Stat f Florida ) Personally Known OR Produced Identification Personally Known OR Produced Identification� Type of Identification Type of Identification r ,oc Produced Commission No. (Seal) Produced Q+^"""�'•, gNNA INGRAM •1^e Neta/ p • " o • my oem ublic - Vate of Florida Commission No. --• " m. (Sg�JOec20, cz-"a,;°rr�o.•" LASHAHNA INGRAM Commission 2d18 "".. Bonded throw # FF 177249 through Na+ Notary P `N'GCom A11C - 6tale OT vionc o a ee REVIEWS FRON R .5i9 �� PLANS VEGETATION SEA TURTLE MANGROVE COUNT49 lIE1N�om i__hKXY* REVIEW REVIEW REVIEW REVIEW SEd arvA o DATE RECEIVED DATE COMPLETED ev.