HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I ,�
' Date: Permit Number: ILQU "O�Z'"I
Building Permit Application
Planning and Development Services
6 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: To Select from dropbox, click arrow at the end of line
'PFPO?5ED il +IPROUEMNT LOCATION r' ig
Address: �7/Vy �, r}�i7� ST< '�P� �L 2V 9 a
Legal Description:
"I 36(//f/J
Property Tax ID#: r_9 V00 -/?0/-1010/ (JOLT - 9 Lot No.�__Y_^^
Site Plan Name: Block No.
# Project Name:
Setbacks Front Back: Right Side: Left Side:
DTAILEDDECRIF "to
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re TC J«' ,�'� f.V I'Yh �067
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C3NSTRUCTIt�N (NF( RNiION '
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€I {{ itiona wor to e e orme Gas Piping under this permit-c ec a appy: w
L❑HVAC Gas Tank Windows/Doors_ ❑ p g —Shutters ❑
Electric Plumbing Sprinklers ❑Generator Roof
Total Sq. Ft of Construction: ,223 Sq. Ft.of First Floor:
Cost of Construction:$ :;)430C) Utilities:Sewer Septic Building Height:
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gW NR/LESSEE4M `� �a; � , CONTFA'CTOR� f
Name / Name: _
Address: --?7/ Company:
City:_ 7�/�'�/C�_ State: Address:
Zip Code:X9/9 cq—/ Fax: OP'le City: State:----
Phone
tate:___Phone No. 0�,l-76 Zip Code: Fax:
�f E-Mail: -7a#, -42 P Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
d1from the Owner listed above) State or County License: _
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SU 'PLEMEI�iT CLE NS�RUCTt N L[ N LAW )NFQRMATION
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: — of Applicab,-,
Name: Name:
Address: Address: .-
City: State: City: State:__,_
Zip.: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ of Applicable BONDING COMPANY: —. of Applicabi��
Name: Name: _.....___.
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance.of a permit.
St. Lucie Count makes no representation that is granting a'permit will authorize the permit holder to build the subject structur.
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit st.;•`r
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 forimprovements to your property.A Notice of Commencement must be recorded and posted on the jobsitr:
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
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_Signature of Owner/Lessee/ nt Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF '54,",z o—, COUNTY OF .
The forgoing instrument was:acknowledged before me The forgoing instrument.was acknowledged before me
this ' day of P b 20 ILby this_day of 20 _ by
(Name of person acknowledging (Name of person acknowledging)
4nahcIl�\am=
4•rgn ture of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
l_ -14q2S;'-- 001. to _NG-0
Commission No. (Seal) C m ission No, (Seal)
�.a�r�,� LASHAHNA INGRAM
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Revised 07/15/2014 '=•: w My Comm.Expires Dec 20,2018 3
Commission#FF 177249 '
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