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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: I ^ty 3 A ' _ 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: ,re� ©rte PRtPOSEDI�NP'�ROuEMET�LOC'ATIQN �g� Address: o `1 Ec-ua Y- DAL" - Legal Description: &D(x is1 ) La1Lts CoeAAy-% CILAI V M0A-'e leab'6 0V E 1Aes be, (o'Scj ) Than Isar+aF SeL(A,-, S�iO W✓1 \V �� 238q -�O3� �2� �,o� � �=taudo Property Tax ID#: ` S 0 © O a as Cv" 02 ZtPoo)Lot No. ,�l Site Plan Name: Irke-Y7--) O rt= Block No. Project Name: Setbacks Front Back: Right Side: Left Side: Tt,�, r� r..,. at.��wze�w.�;.� ,.. °' r r ^�' § w4,*.'�. �i3�r -;`c s F (I� 41Wrw.�-} .L�.+"+a-^^ aj. ,�hz.% Fig'{'*n 1011T ILED DES RIPTION OFrg1N0�RK: �, r �k s T A �� 3 T' N S-7 PN t�t_4�-r c7�l (:::)C- E��r i ea. Y-)e .S V) L&-i-4-e rs. r t1 hs:+. P ` of"lr 3;:k y .� Cb4 d 4F' N CDNSTRt1CT[ON1NORMATlON � Additional work to be pertormed under this 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: Cost of Construction:$ 33 Utilities: '—Sewer —Septic Building Height: 01I1NER/LESSEE CONTRA Name A. GYe 0 Name: M. raw, VaVI asse� ddress: Company: 'UNIT ri cA yke ShLA.' V State: 'Address: ?S ln0 N )z Zip'Code„ 3 q� ) Fax: __ .. City:' ; `�� C'.�(r Stater P °I�. L-401 �9� 2©3`7 .,i o`�F -Zip Code: 3 � I Fax: Z E-Mail: �`- &G iQ Q aYY7 Phone No Fill in fee simple Title Holder on next page (if different E-Mail- A\J 1NN,"Y, riC, from the Owner listed above) State or County License ; a y �)q 0 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. S� P�?LEI�ffNTP►L CONSTR�IICTION IM"'M / — Pp MORTGAGE COMPANY: _Not Applicable DESIGNER ENGINEER: Not A licable 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. ®r )1-2 Signatur of Owner/Lessee/Agent Signatul of Contractor icense Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF S� ��' COUNTY OF The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this -` day of 20_ by this 4—day of 20A,_ by (Name of person acknowledging) (Name of person acknowledging) )V\.1V4 dn-e" Signature of Notary Publ c-State of Florida) (Signa ure of Notary Public-Aate of Florida ) Personally Known OR Produced Identification Personally Known OR Produced IdentificationW�� \' Type of IdeDtification Type of Identification Producedl-L. SZa- Ja-U+U1& lam. Produced Commission No. (Seal) LASHAHNA INGRAM Co fission No. B, N, {Seal),.�WGRAM ,L.• rc�gfofl���� Notary Public-State of F orida •-_nCr rt,r E � gil es Dec 20 2018 * ; "woud'3 ommission#FF 17 249 Bonded u,,,',REVIEWS FRONT Leon e(RW. f d@@Ret ryA S VEGET I COUNTER , W REVIE REVIEW REVISE DATE RECEIVED DATE COMPLETED ev.7/2014