HomeMy WebLinkAboutBuilding Permit 1
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _
Date: Permit Number: I 01 ®?x: 1
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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 LI
PERMIT APPLICATION FOR:
R"CC3SED INfRn�%EMENT L®CAT ?'N
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Address:
Legal Description:
Property Tax ID#: ' I�� 50 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAIL E ®ESCRIPTI®N
�� ear. .. 30-
Additional 30-work to be pertormed under tis permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: � Sq. Ft.of First Floor: 1aU
1
Cost of Construction: $ Utilities: —Sewer _Septic Building Height: 2
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OU1fNE4R/LESS'EE. � M,'pQNTRAC SUR _
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Name �� �r Name:
Address: Company: 1 xTcti, ,L
City: State: Address: 5 ( q. sL,0�6 pvU
Zip Code: Fax: City: �;J wyr ' State: f
Phone No. Zip Code: 3gIS( Fax:))d,—a64'6'%OZ
E-Mail: Phone Po
Fill in fee simple Title Holder on next page (if different E-Mail 1J 4C_ (-1
from the Owner listed above) State or County License Cc(— G ?�S
If value of construction is.2500 or more,a RECORDED Notice of Commencement is required.
SUPPI:EM'ENICAL:CaNSTR[ Gl'I:QN ,L1,Eldl l,A�llll N�QRMATI �I: � 'T � k' p,
'!P. hl xli & `a�. #'€b, "">le 'a wi§x `M;S .•� �' sem;, ,==N F NIP .e.r,,....
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 o your property. A Notice of Commencement must be rec rded and posted on the jobsite
before the firsJ inspection. If you intend to obtain financing, consult with nder or an attorney before
commencinR Nkork or recording our Notice of Commencement.
Signature of OvyLessee/Agent Signature of Contr t /License Holder
STATE OF FLORIDA.p STATE OF FLORID
COUNTY OF COUNTY OF A o
The f r oing ins ment was acknowledged before me The forgoing instr ent was acknowledged before me
this day of f_ 206 by thi�day of 20 by
D� A),p ��,.,) cr
(Name of person acknowledging) (Name of person acknowledging)
AZSL�LLL // , - I
(Signature of Notary Public-State of Florida ) ig ature of Notary Publft'6 State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
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Type of Identification Type of Identification
Produced Pr duced "
� LASHAHNA INGRAM
Commission No. .,�������,, (Seal)LASHAHNA INGRAM �o mission No. ;a°�.a u« Notary Public-�§� Ipi Floris
,2°s»aY Notary Public State of Flo i01a -, + y omm.Expi es e6 20,
" M Comm.Expires Dec 20, "sN• ou`: Commission# FF 1772
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4* °�, C mmiss ti al Nota y Assn.
REVIEWS FRONT ��4�>�'tRIG Bond(d CANS VEGT T11 SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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