HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: l�1 V• f�3
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:
P�tal?OSED lNR01%EMENTLO'GA1'ION y
x war , R ,
Address: 111 �1j�JL!7aL Atrf- �a�-1- 5-. r - Z�� 2 C �'i`q6�
Legal Description:
Property Tax ID#: 3 Z_// 11� ~ 62.S;5, 0b6 - 6 Lot No.
Site Plan Name: Block No.
Project Name: ✓�O�'a� ��^'r'G'�
Setbacks Front Back: Right Side: Left Side:
3k x
DETAILED DES6 PTR OF WORK �
.-s..,✓'r ,,.� .,., <. - az ,a a�' 'v.,.�a. z .'Y :� d�a
/0 A t/ IVA,,
CQN¢STRl1CTlt?,N lNFORI�IATlON tx 3
Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters -Windows/Doors
y Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
'ov1%NEFt/LESSEE " CONTRATOR
Name= Name: J-.4 0;., / Lot®rte y
Address: 1"06 f) :akrd &I A UP Company:
City: State: rL Address:
Zip Code:2332c] Fax City:/P,-r- sAl"-r State:
G
Phone No. Zip Code: gV t ry Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail �'/�'yJ�yG�i6rr t ���e Td-rgL-
from the Owner listed above) State or County License
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SllPPLEMEWL CO�NSTRUCTIE7N LA N LAW IN=EORMATI(3N 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 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 our Notice of Commencement.
ignature of Owner/Lessee/Agent ignature of Contractor/License HoId4r
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF _. COUNTY OFcsL
The rgoing instrument was acknowledged before me The forgoing instr ent was acknowledged before me
this day of 00-k ,2010 by this day of 20 I� by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-glate of Florida) (Signature of Notary Public-_SSte of Florida)
Personally Known OR Produced Identifications Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced rdured
_1 It M a������. LASHAHNAINGRAM
ANNA .•taR�"bB;'',
Commission No. F LASH state 15GO Sion No. 14 t60. )blic-State of Florid
public 20 2018 =n,y.Cnmm c�oires Dec 20,20181
`APPY PUB�.,� Notary ices De _ ..
.c's omm.ExP 77249
=•: ¢o� COMMissro too Nota�as
REVIEWS FRONT (3, ., `o�,; B Ifi'' -A PVEGETATION ` SEA TURTLE MANGROVE
COUNTER RVI "1", , REVIEVI/ REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. /2014