HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFOVUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
.. ..,..7a«i•. 4
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:
PROPOSED INPROuEM��I IT LL}CAT�„O,N„ a
Address: 7dQg AAyf�;c- Waa,a -e_ FL 3toA0
Legal Description: PRrce( 11A 3 3 .2a— 000
Property Tax ID#: ac. (Pao• cc)cn • c)OO1 Lot No.
Site Plan Name: Block No.
Project Name: ”
Setbacks Front Back: Right Side: Left Side:
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DETAIL D DESCRIPTIONPWOR `r
9e a(a
NS1'RUCIO INF_ORMATIO�N, x �'
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� :e "' NOW
Additional worK to be performed under this permit—CheCK all that appy:
_Mechanical _Ga ank Gas Piping _Shutters _Windows/Doors
_Electric Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ ASO °b Utilities: _Sewer _Septic Building Height:
01NNER LESSLE `" 'C NRACTOR
T' ,
Name (+e� ��e Name: b
v t
,
�l e[fdv
Address: 7 0 9 61't Company:
City: Po S L L-vc =-e- State: i%L, Address: )31 Stj
Zip'Code: 3 c11/SCP Fax: City: L State: f-&
Phone No. Zip Code: ?61*9 Cn Fax:
E-Mail: Phone No 7 7 a 2 27!. co0o
Fill in fee simple Title Holder on next page(if different E-Mail .9 J, �-from the the Owner listed above) State or County License C r(--/Yd V0 S 7
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEIY/IENTAL C®NSTRIJCT I®N LI'EN LAWIN:FORI\/IATI®N::
RN'
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
commencingwork or recordingour Notice of Commencement.
/- 0� Q-
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S ., COUNTY OF1.�rr t
The forgoing instrument was acknowledged before me The forgoing instru nt as acknowledged before me
this day of 20 Ito by this 1�day of 20�, by
(Name of person knowledging) (Name of person acknovAdging)
AnAre of Notary Public-S e of Florida) ignature of Notary Public-s6le of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced _
�.�s. 3yy' O x
aY r�o, LASHAHNA INGRAM
Commission No. S I Commission No. Sgel}y Public-State of F or a
ay r, ; : •=My Comm.Expires Dec 20 2 8
�,,,"� "..-:__•�- =9' Commission#FF 177 4
LASHAHN INGRAM r a.`
Notary Public State of Florida, Bon ed through National Nota A n.
REVIEWS FRONT ZO r@ U[Rf M/&CERpi es FtcA1PJS01 EGETATION L` 'fQ i
COUNTER REV ,lF �41 �RE\AEWissio #FfE\YJKMP REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014