HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ��I flame
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00 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:
PROPOSED INF R`OVEMENT 6tATION.
�r
Address: L C0 VE W )r
Legal Description:
Property Tax ID#: 0 00S_ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK ' a`
COIVSTRl1CTl0N, IIVFORMATIOIV g
-,.
Additional work to be performed under this permit,—check all tat appy:
Ilk Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:�69' 4�/
Cost of Construction:$ 7qo 0 Utilities: —Sewer _Septic Building Height:
OWNER/lE5SEE y 5
NT
Name
�u
Name lo ,Yl k QP- 41yCAl CA IVA Name: C CSSPA it P P-(-*"
Address:/100 IV, IR,-/ On ST Company: -rw(ry C DG lid I Yl C
City:f 11q�r(9 r c' State:A�C Address: <,G7 S - IRQ L(-a(/rT Cr
Zip Code: g Z�`.S Fax: City: AS/_ Stater
Phone No. WO ("33 7_ -7 Zip Code: X42 S—Z Fax: ff
E-Mail: Phone No_2� Z _Z40 _31 _� y
Fill in fee simple Title Holder on next page(if different E-Mail_7WI PVCDQ(1 K4 2 V SAVa - CQw/
from the Owner listed above) State or County License C{4C ( K l,6 20�J
Ltt
of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLE11lIER1TAL CONSTR"UCTION LIEN LAW IN:F,ORIVIATION:
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 thepermit 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.
Signature of Owner/Lessee/Agent Signature of Contrac or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF St',l ,.o COUNTY OF S '• ,r
The forgoing instrument was acknowleclgc before me The forgoing instruM ent was acknowledged before me
this IS' day of 0C-A ,2015_ by this IS' day of UCC ,201 by
(Name of person acknowledging) (Name of person acknowledging)
&a
gn tune of Notary Public- to of Florida) (Signature of Notary Public-S to of Florida) \
Personally Known OR Produced Identification Personally Known OR Produced Identification, V
Type of Identification Type of Wgritffication
Produced Produced •D51?_0..._ __
- NA iNGRAM
Commission No. Commission No. a , (Se9{)state of Florida
LASHA NA INGRAM ., Expires Dec 20,2018
°K State of Florida
Notary Public commission#FF 177249
212:. My Comm. F 177249 +_�' Bonded throug a ion
REVIEWS FR ;,T o f�NIIge iss ori
rou F W7, �' PLANS VEGETAT,f l' SEA T'R L . ANGROVE
COU `'1'tE� th g REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014