HomeMy WebLinkAboutBuilding Permit Application (2) All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1 `' ' ®(q I
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:
Tw3r -�++e. ,wrr '� ' ' c� - .p""' i
PROP®SED 1NPR. U MENLTIB CATI �
Address: �
Legal Description: kyt RW 1ccJ 1)),41t)Ok 8L0 Ck ! Lor 13
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Property Tax ID#: M/08- 703 - 6C)V5 -0 0o-LO i, Lot No. /_3
Site Plan Name: A41Jr k ii Block No. 6
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Project Name: d
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Setbacks Front Back: Right Side: Left Side:
1410�ED DESC I TIO O�WORK � ��z _ . Y
LI4e67 to,F134iR, _DA^46`C-b 000.D S/blAla
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CON5 RIITIONi FIN."
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Acid Mona I work to be performed under this permit-check all that appy:
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_Mechanical _Gas Tank _Gas Piping _Shutters it Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
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Total Sq. Ft of Construction: ✓, � Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
090111
NER LESS E '�C�ON IRAC1=OAR.:
Name `7'/%!7 Cs iA2��n1 fl Name:
Address: oZ IJ YyW _,DL Company:'
City: /-op-r- b ESC' State:F4 Address: ev
Zip Code: Fax: City: lla' �' State:
Phone No. �a/q1 y0- 3 jga Zip Code: ' ° ' 1 Fax: .
>y
E-Mail: -1-46tAkb 6^4it. 00/y Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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S�11'�PPLEM�ENTAL CONST �UC�TIO,N LI'E:N LAV1/ I�NFw��RI�/IATION:
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: J1
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 reviewc'Iroom 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.
mature ofOw r/Less e lCo ntrdLtor as Agent for Owner Signature of Contractor/License Holder
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STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was,acknowl edged before me
this La day of 1,110 20Re, by this day of i ______'20- by
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(Name of person ackn ledging) (Name of person acknowledging)
�cAd �i
ature of Notary PublicV State of Florida ) `. (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification `7 Personally Known OR Produced Identification
Type ofn ifi tion _ Type of Identification
Producer �lQ •$1l0•lo�-a'�� 10 Produced-
Commission No. (Seal Om ► No. (Seal)
LASHAHNA INGRAM�
Public tate of Florida
-
my Comm.ExPil es Dec r i
REVIEWS FRONT ZO (• iJPESV[Sop�n#F��''bn'� VEGETATION SEA TURTLE MANGROVE
COUNTER REV. 11:;,Q,; '- Rr�i�AkEU1�°9hN t;°I� V1'EW' n REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE i..
COMPLETED
ev. 7/2014
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