HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _
Date: Permit Number: I /(0 05 -03q
f'
-- Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 1✓/
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
id.
� s��as
PWffi'SED INPRO EM'ENl'�LOCATION T
�`d�;:.�.� a-n.,�-�
Address: 1410 S 0CF-EN -DR. u N 1 ) fttc)- d8 I.
Legal Description:
Property Tax ID#: j C� -�►1®a C) �� I' Lot No.
Site Plan Name: Block No.
Project Name: �DN
Setbacks Front Back: Right Side: Left Side:
D�ET�AILE� ,DE�S� }I�PTI®N OkF 1NORK � � *� 'Ygjv
°w R_bti �,rrtlt
IgEMDYE `TI LE ,71D�9: aJ ALL I M SHexweR, 231.4)-iD TILS , �" . QEPI_4CI
DLn �r-Io��l�L Uc4LUL -7-0 rtp-cy 6r-JF— AND S�rk,lsr2 PAI
I
CO�N5TRl1CTLON IN1=®R+11J(AT((JN �'� x .
Additiona work to a per or ed under this permit-check all that apply-
-Mechanical
pp y-_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
Electric ✓Plumbing r _Sprinklers _Generator , _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ o?, QCY)°O Utilities: —Sewer _Septic Building Height:
I'
9
®WN16R�LE,%* E: � 'CE®NTRAGTO�R
RTI
Name `J>D N A L0 -J-0N Name: ,4,VA4 (LC-52t AUI t4 _
Address: Corn pany: 5-6(2.4TJUAJ X-�
City: loe F ' AeRce- State:F-L Address: 1 f �L- C24�Pot n1 i 0 2
T
Zip Code: Fax: City: Stater
Phone No. 3D5'— ,� ` �'p3� Zip Code: Fax:
E-Mail: 7J'DtN�F-5,4LE&p, )A6Q!1 A ZEi- o-,4 Phone No / -770 -,Y-51-1-4236
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License .II STt>4'T&
i
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
L
Ili
�WI M� `RMAMTIM.N. M11:9,
m.
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 insp tion. If you intend to obtain financing, consult with lender or an attorney before
commencing wo k oA r cording our Notice of Commencement.
zt)L�- �
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA, STATE OF FLORIDA f
COUNTY OF >, COUNTY OF e, -,+ UL-[,e,
Thegoing instrt was acknowledged before me The forgoing instrument was acknowledged beforp me
thiKO day of 1 201 by this day of 1Yb.02016 by elfin/S
(Name of person acknowledging) (Name of person acknowledging)
Sig ature of Notary PubliO State of Florida ) (Signatu a of Notary Public- a of Florida)
Personally Known OR Produced Identification Personally Known F O.R_Pro- u d d t' 'c .io4�z ( Aq
v
Type of Identification Type of Identification
rR� �e,,, DINAH G. CUSHMAN
Produced Produced C?�L :'k°s ,d 9--6iblic-State of Florida
— °• : _My Comm.Expires Feb 28,2017
C ion#EE 879042
Commission No. Commission No.EggQ9i
Notary
INGRAM Bonded Through National Notary Assn.
*�= tary
LASH
St,t, 3
s•, t� omm. Expires Dec 20
REVIEWS 46M"' 'ZONMG? " :SU�p li ISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014