HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BMPLETED FOR APPLICATION TO BE ACC__ .! D
Date:
p
SCANNED Permit Number: 1 (1l0 Da�
BY
St. Lucie County
Building -Permit Application
Planning and Development Services
Building -and Cade Regulation Division
2360 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: a� `� 6CPIN
Dal VIE ()N lY 1008
Legal Description:
/_
Property. Tax ID#: - 3535 &02
OOgC7 000�i Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back:
Right Side: Left Side:
(..19/ilrJ�i i k}Nlj [�v�rr�-Tap
�j�LITc,1-4EIV
wey' &ErL a ru o f 6t 5-r 6, (AlAu, /Av 16-re—tA Al
itiona work to be pertormed un er t
is permit- check all that app y:
_Mechanical _ Gas Tank
_ Gas Piping _ Shutters _ Windows/Doors
Electric Plumbing
_Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: zoo
Sq. Ft. of First Floor:
.Cost of Construction: $ 20 . aa-
Utilities: —Sewer _ Septic Building Height:
Name L4tl
Name: TDAV I D W142-FI-f�/J
Address: P930 Company: UL-TiK^AVr, U✓ING SP14(45-5
City: TEvvsej 59Y1y"
State: _I- Address: blJo 13t/A- VAnts %
Zip Code: 34 IiS=' Fax:
City: ►ijWF "I State: -rt-
Phone NoJi3k Z(P4 `i'4Zl
Zip Code: Sq I I ol Fax:
E-Mail:
Phone No 11q-9 314 9831P
Fill in fee simple Title Holder on next page ( if different E-Mail CI _ KAAR Tl nJ 155 & ) L4 Nao . C6w
from the Owner listed above)
State or County License CGC J523 % "t
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
or
Name: V �
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: %Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _L Not Applicable
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name: y `
Address:
City:
Zip: Phone:
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 inspection. If you intend to obtain financing; consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
Signature of Owner/ Lessee Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY
STATE OF FLORIDA
OF
COUNTY OF etis_
The forgoing'instru grit as acknowledged before me
,l day t�
The forgoing instr ent was acknowledge before me
L ��
this of 21 by
this day of 20� by
Q1` A I K JAlA)
MQWZJv �0
I
(Name of person acknowled ' g)
(Name of person^ acknowledging)
( gn re of Notary Public -State 8f Florida)
( !gnat r of Notary Public- State! of Florida) '
1
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of ]dentificatio
Type of Identification
Produced
�04 �����" .: NAHNA INGRArn
+� - 4t.% Notary Public - State of Florida
Produced
•"""p •. LASHAHNA INGRAM
; r%'•
Commission No. 2' . •z COmfl% �)es Dec 20, 2078
Commission No. :+ v os Notarljl Wy - State of Florida
•�'" COmmission # FF 177249
e • . . • 3 My Comm. Expires Dec 20. 2010
'•.,,�.
,9 lIW, '_
P?c°- Commission # FF 177249
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Rev. 7/2014