HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I �/
Date: 3 20 I Permit Number: / /�7 0 3' o4
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DECEIVE®
11111111111111110 Building Permit Application MAR 2 0 2011
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 MPR®VEM.ENTLOC/ ye ATION:�-fR.
Address: 5'0 2 Coo�(%t�'I�r� T'7: ����'� dg/}
-
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name: ' '449"g!F(A"'0"'b F4 Ole-Ile.
Setbacks Front Back: Right Side: Left Side:
DfT�AILE® DE�SC I�PTIO� OF 1NORK:
f z:_YJ A4 I 1. 9 ! �P `�.e, 4 �
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CONSTRIJC I0'N INF®_RI1nATl'0'N;:
Acid itional work to be performed under this permit-checK all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ P �� Utilities: —Sewer —Septic Building Height:
01N '.ER/LE%SSEE:
Name: , eo
' e ��'159�3"CIG�ZO
Addresss � d rlydl�c. Company: el
City: r //E�e^l'� State:�'� Address: "7 4
Zip Code: `3y/l / Fax: City: � 11-n State: rL
Phone No. 3�2_— ! fJ je 3 Zip Code: .p Fax:
E-Mail: 0_rtV 0-61 e1 1-'M e �_ a-o/ C n^-1 Phone No
Fill in fee simple Title Holder on next page (if different E-Mail "14 f ��ta�1 2c'►�tf✓e �c»'�+
from the Owner listed above) State or County License (��'C' G � 73,5
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUF'PLEMENTPL CONSTRtJCTI®N LIEN LAW I`NF®RMATI®N:
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 fender bran attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDy STATE OF FLORIDA , (I 4 .
COUNTY OF l-�/I �I� COUNTY OF l�L
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this�day of 60CJn ,20 ("7by this J day of �,'G� , 20 101 .by
(Name of person acknowledging) (Name of person acknowledging)
c_
(Signa re of Not bl' State of Florida) (Sign r of Notary- l/ic- ate of Florida )
Personally Known ro Personally Known � Rl Pr dentif Po
Type of Identification o3a e� Ty a of Identification Nor�Rr co MISSIONgFF98
YP rrnao PUBLIC 6
Produced 010Z'0i Aey4 S3a1dX3 d031r1 Pr duced EXPIRES May 14,202
onend 908611 q NOISSRNWo: AHV10N - ttCR�GN WNOEO THROUGH
Commission No.
H-LIWS� �INN3f r u o mission No. INSURANCE COMPANY
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.