HomeMy WebLinkAboutBuilding Permit Application ;1
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED n�Date: Permit Number: I ")u
�J�-�--
,
,
r� ,
r
- _ 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: (� �� _U�� r
c,r Li Lu
W%W4
PRaSED 1N=PRt�3UEM'ENjj' ��OCA�TIUN,: .�
Address: C/�1
Legal Description: �' -C ?\Ct a G - U a �40o4- Lo- - a-�iIL(
Property Tax ID#: c�' D _00914- 000 - 15 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Mr
Df AU ffli 0 SCRaIPTION dF 1NOR�K: Elam
Q10 0)la u '? cw u ski (,J IA4-
Uc,,nu x `I -Vc w t`1 IS f%� � lie aI
C®NkSTRat1CTI0N RMATI,ON: k
under
99���W
}
A OEM
Additional to ape orme t is permit-check a that appy:waI
_Gas Tank _Gas Piping _Shutters. _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
C�
Cost of Construction:$ ��t Q Is Utilities: —Sewer —Septic ' Building Height:
OWN!ER�L�ESSEE CONTR"ACT;€R
Name `�, C/" Name: U i,Q'
Address: ,�G ( rJCn`�.(L� Company:/ A cks:a r S ( p
City: Pi /
VISL. f State:PL- Address: !/ ,�LG r as-9-G A� 'p
Zip Code: 7>q q(R Fax: City: P�__ pl per_..' State.
Phone No. W)- P7,C�Q( Zip Code: Fax: -�� - 9 D. 1--�/y9
E-Mail: Phone No % a (
Fill in fee simple Title Holder on next page(if different E-Mail 1C
from the Owner listed above) State or County License _rll� c t F1 IQ57811?
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
121R`Ll'CTI00 N LIiEN L�1W IN.FOR p►�'IQN:
-01
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
befor a first inspection. If you intend to obtain financing, consult with lender or an attorney before
comphenring work or recording our Notice of Commencemen
Sign a of Owner/Lessee/Agent Signatur o Contractor/License Holder
STATE OF FLORIDA STATE F FLORIDA '
COUNTY OF < COUNTY OF S L
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 11 day of 20 Ko by this V day of 2,b ,20 o by
(Name of person acknowledging) (Name of person acknowledging)
11wnature of Notary Public-Stale of Florida ) (Signature of Notary Public-StaN of Florida)
Personally Known OR Produced Identification Personally Known d dentification
Type of Identification Type of Identification ,��<Pa�^°� '
Produced VL �3toa `� ''15.aSfl Produced =• * *"= No LASHgHNAtNG�AM.
Y Public_
Commission No. (Seal) Commission No. MY ° �� Stato of Fl20da
o;o�F�o�°• Co EX�fres Dec 20
io/q 18
IZ
8o�ded through Natio°� 1I7p49
LASHAHNA INGRAM Notar
z n «�: o ary lic-.State of Florida
REVIEWS FROM ;� �] Com gifI ,ggf�jRO 8JPEVIEW
LANS VEGETATION SEA TURTLE MANGROVE
COUNT R'%:F„;, VIFomm ssiorE7pgg REVIEW REVIEW REVIEW
'8 ded
DATE U``.'-'
RECEIVED .
DATE
COMPLETED
ev.7/2014