HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
_ 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 . )C
PERM IT APPLICATION FOR:
Address:.900 Av, .
Legal Description: &1r3 0 7 ZYLrM 7
I,
Property Tax ID#: L 30/ - 60,/-- Oo"- c�wO 7/ Lot No.
Site Plan Name: Block No..
Project Name: M PrJ'o h
.Setbacks Front Back: Right Side: . Left Side
t h ti I 3 O,ee h k" O7 U�O�M ✓JGf d�GG/ �o l G�D I 't e
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Add
itional work .
to e performed under this permit-c ec a that appy:
chanical _Gas Tank _Gas Piping Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
" I
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ ,.2/Y t Utilities: _Sewer Septic Building Height:
Name o� Joh Name: J f
Address: X 00 y s4af�A .4 -t Company: C`o�+rf�0 ,�?�cii ),W J'
City: . ��• c%c State: Address:_/2 �! ��• Lvt ���
Zip Code: 3 V 9s/ Fax: &,gI4 City: �I�r6r Stater
Phone No. Zip Code: .7 Fax: •2 71-
E-Mail: Phone No. 77Z yW
Fill in fee simple Title Holder on next page(if different E-Mail: 7-0"-71 �Slc,k J G Q k�,kvo, c�
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from the Owner listed above) State or County License: Secc 13//S/SDc?
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: of Applicable MORTGAGE COMPANY:. _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Pho e: Zip:. P one:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: 09 city-
Zip: Phon 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 pfior to the issuance of a.perm it. -
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 covenarits 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.
gnature of Owner/Agent Lessee nature of Contractor icense Holder..
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5 , COUNTY OF
The fpr oing instrument was acknowledged;.before me The forgoing instrument was acknowledged before me
this 1�. day of �tQA- LLL by this�day of �e is ,201E by .
(Name of person acknowledging) (Name of person acknowledging)
(Slgnature of Notary Public- tate of Florida) (Sign ure of Notary Public-Stat of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification .
Type of identification Produced Type of Identification Produced
VL -
Commission No. (Seal)- Commis io No. S
LASHAHNA INGRAM
INGRAM k
r,,,%.
onY nLASHAHN P B�:'•; Notar .Public State of Florid
Notary Public _ ,
es c 20 p018 :., My Com .Expires ec 9
REVIEWS FRONT ZO _ A4795'f 'Ep 'nl;/� 9 VEGETATION" RTL(Pm iIPAI (�i
COUNTER REV ;9l �;:REVli�O�issio a#tii j iFawssn i REVIEW _"''J��2 �IBOndedlhoug tar As
DATE ���'"
RECEIVED
DATE
COMPLETED
-R—ev.7/2014