HomeMy WebLinkAboutBuilding Permit All APPLICABLE INFO MUST BE COMI -_._QED FOR APPLICATION TO BE ACCEPTED --
Date: Permit Number: '`•�s��--
RECEIVED
APR 24 2015
Building Permit Application
Planning and Development Services PERMITTING
St,Lucie County,FL
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:
PRC}POS'E'D 1NPROUE' LOCATION. y.
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Add ress: 'IC51 N 1AG-,4 A k
Legal Description:
Property Tax ID#: (0 - SC>Z • Qono- onm Lot No.
Site Plan Name: \ ` Block No.
Project Name: Coy" k S CCN eray � 3
Setbacks Front Back: Right Side: Left Side:
).ETAILED DESCRIPTION OF WORK . F
CONSTRUCTION INFORMATION
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itional work to be performed under t is permit-c ec a tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1 �6�t- Utilities: —Sewer —Septic Building Height:
ovuNlR% EssE:
ti- v-.
CONTRACTOR
Name 613&�ksLel,S�G.Ch ���, Name:
Address:�5lrpo- f-4 A I I� `'? c :Company: ,, Sig Q .-.N,ccs.e�l,.o
rs �
City: State:q`Q Address:� .g. Sc;] . �e ^ �d
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Zip Code. 2N q 9 fax:" City: ' �;�f� �;ca e,t�� State:
Phone No. ')17a 'q(-oq- /180 3Zip Code: 3 Fax:
E-Mail: &-i-��� Aes4 (1- Smw\ ,may Phone No. 77`, Sc2.R JAtJ(
Fill in fee simple Title Holder on next page (if different E-Mail:
from the Owner listed above) State or County License:CQc1_1z59'Woo
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL N LIEN L 'INFpRMATIQN
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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 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 I lender or an attorney before
commencing work or recording our Notice of Commencement.
�SignatL41re of Owner/Agent/Lessee !Sign ure of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF SSI .1 �.e.s COUNTY OF
The forg,�oing instrument was acknowledged before me The forgoing ins ment was acknowledged before me
this M, day of 20� by this day ofu20,(IC_ by
(Na of person acknowledging) (Name of person acknowledging)
natu a of Notary Public- tate of Florida) ' ature of Notary Public- ate of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produ Ty e of Identification Produced �� `
LASHAHNAINGRAM P-I.2SS13•tol,- LASHA arida
`' Nota u�{hc-State o'
Commission No. .M :(SN�ry Public-State of Flo •di mission No. '/ �,�'; ��� x fres Dec 2018
My Comm.Expires Dec 20,2018 ; My Comm. P FF 17,249
°o` Commission#
%9.. Commission#FF 1 o-• Assn.
''�� ��•`' Bonded Inrough National t�jtary AssmL '��„„��•`` on _;�
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