HomeMy WebLinkAboutBuilding Permit Application I
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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
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PERMIT APPLICATION FOR: 4- roof- -c, ,i 6;a_ck_ pz,r-ct, A--N%,_
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PROPQSEaD IN,PR®VEMENT��L�CATIQN� s � . �'" a . ,� �,, �ti
Address: 40% USI( OLOS Ave Port Saint Lucie F 1, 3U45a
Legal Description:
Property Tax ID#: 94 ICI - 510-01618 - 000—6 � Lot No.�
Site Plan Name: it Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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CONSTRl1C'�TIOIV IN'F®Rlti/IATION:,,
Additional work to be pertormed under this permit-check all that appy: I
_Mechanical _Gas Tank _Gas Piping _Shutters _windows/Doors
Electric _Plumbing _Sprinklers _Generator Roof
Total Sq. Ft of Construction: 5co Sq. Ft. of First Floor: :'I
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Cost of Construction:$ Q150• Cao Utilities: —Sewer —Septic ! Building Height:
01NN'ER/EESSE CONTACTQR
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Name ArielS rand Elizabeth Senaf6ir Name:. Ae Roth6 ° CO (Richard vJ IrachuK
Address: X10% WIhwD Ave. Company: Andy the P,, '<V r ° Co
City: Port Stunt Lucie State: FL Address: i'Igl _�F mnr �a Rrl
Zip Code: 3UgSa Fax: City: Port Sajrt 1_U6e1- State: rL
Phone No. -1"la- 3661-935% Zip Code: 34g5D- 'I Fax:
E-Mail: Phone No 1'►a - $"lq -MSS:�.
Fill in fee simple Title Holder on next page( if different E-Mail rWaril IM0, urn
from the Owner listed above) State or County License °f14 1 V
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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man I�N�FOR�II��4TION
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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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Nlitice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 4aA. _11�J COUNTY OF V13_ o
The forgoing instrument was acknowledged before me The forgoing instrument was acknowled ed before me
this�day of ( 20)lo by this �� day of 20A6 by
(Name of person acknowledging) (Name of person acknowledging)
ignature of Notary Public-State of Florida ) ignature of Notary Publi -State of Florida ) GppM ��da
aye olFo
Personally Known OR Produced Identification Personally Known OR Prodyc` Id �i�atr�r� c2
Type of Identification ype of Identification '' ExP`�es FF p s
,,•a��, s Gomm.
Produced roduced ;
(�-f)S .(0(0'g0y IASHAHNAINGRAM c$. q, Gomm�s hNad
,.��av'p'�B�>,. u 11ic State of Floti�d 8 '. ►o?
Commission No. P �.�•; t(d @4 s Dec 20.2 mmission No. .
My Comm:
Expire#.FF 177249 o;F
-'' •Qe Commission
°lary As
R`o-�°•` Bonded t ro
REVIEWS FRONT �� � SUPERVISOR PLANS VEGETATION :-SEA-TURTLE MANGROVE
COUNTEff REVIEW._ REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014