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:(7.72)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of dine
Address., 3 ,6ore-4 Oi'
Legai Description: ,Z01 d PP, k?1V,0-01 'lt u J t,�r�J� 'r3�7'" AV4 LTO
0100- '/6J— `C7
Property Tax ID#: %Iy doZ ` S62- 03 73 " DD Lot No. a
Site Plan Name: Block No. 43 O
Project Name:
Setbacks Front Back: Right Side: Left Side.
4
Additional work toe e orme un ert ispermit—c ec a appy:
HVAC F]Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
0-Electric 0 Plumbing ❑Sprinklers Ii Generator Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
,j d- .
,2 Utilities. `Sewer-
Cost of Construction:$ 7Septic Building Height:
t3
Name /TSS /0G0''er,7 Name:;?Ig,00"f cr l G
Address: ' Al ,-� �✓ Company: Go
City:,
Y •���"C
State: Address:�,6,2�6�. L z
Zip"Code: 3'4t*i 2 Fax: Al City: State: he
Phone No. Zip Code: . !f 9 416 Fax:7?2-S SS
E-Mail: 6 Phone No. 77.2-r/6//-
Fill in fee simple Title Holder on next page(if different E-Mail: 7—o n�, ,i'/�t rC. ti?YRv.Go.•-c
from the Owner listed above) State or County License:Scc t !!c5"`ro
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
I
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: z 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: hone:
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 mint`be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, cons O It,with lender or an attorney before
commencing work or recording our Notice of Commencement.,
s
_Signature of Owner/Lessee/Agent nati:, a of Contracto lcense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF L v COUNTY OF
The forgoing instrume��twas acknowledged before me The forgoing instrument was acknowledged before me
thi al>day of 201-(,-by this Pryrlay of ACJ 20 -&by
TyN,0yV,0s LA6,t
(Name f person acknowledging) (Name of person acknowledging)
(S ure f Notary Public-Stat f Florida) ( (Signa ure of Notary Public-State f Florida)
Personally Known OR Produced Identification Personally Known Produced Identification
Type of Identification Produced Type of Identification Produ d
_ �a p�Jp.
SPµ''oaf, A INGRAM
`,�� (, LASHAHNA INGRAM a�*� otar, PubIIC-State Of Flori'
Commission No. ;: PIo � �blic-State of FloriJa Commission No ; .• f Tim.Expires Dec 20,2
« : _My Comm.Expires Dec 20,21 1�' Commission#FF 177299
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, i onaI Notary Ass
Bonded through National No
Revised 07/15/2011
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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DATE
COMPLETE
INITIALS