HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: !r�
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RECEIVED
�..._. _...___µ ... Building Permit Application APR 10 2011
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34952 �/
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential h
PERMIT APPLICATION FOR:
PROP,QS'E_D INPR,0�1/Ep�M,ENI' LClCAT10'N:
Address: ALO, DA_ PC)� Elm LJ 3'7 1? 2
Legal Description: li'^Av vC,ri reaa-Tis um CT GDT 2-� BOK S
Property Tax ID#: 302 — 0q — 012-0 — 0001 Lot No. 22-
Site Plan Name: Block No.
Project Name: UJIN+)Dvj (t('K'AcCmrewS
Setbacks Front Back: Right Side: Left Side:
Dfl'AILD D.=SCRIPTI®INS OF OR,
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CONSxTRlJCTI-Ni INFO MATIO'N:
Additional work to be performed under this permit—check all that appy:
_Mechanical _Gas Tank —Gas Piping _Shutters _Wind'ows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ 3- Utilities: —Sewer —Septic Building Height:
01N IEyR/�SSE�E; C0 'TRACT®'R-
Name %A tj UotC.1C Name: CIAO KR,6LJC)C
Address: LIQ 3 P,dc,An n1t, Company: SOU T-W e'LW p sl6m C C
City: J5_-44,'s PIO&C It State: Address: P_a� Qvk �OZS j
Zip Code: :2 ?z Fax: City: S-OIJJ-T CLayb State:
Phone No. 407 -7 6 I — W'zI Zip Code: 3"/77`0 Fax:
E-Mail: bri QA vs o(a'Tl\c to C],,Lsj Ons. h 1 L Phone No
++ -70? — W Z I
Fill in fee simple Title Holder on next page(if different E-Mail brk n E? 5o iatr w dzs,
from the Owner listed above) State or County License otc V4
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S 'PPLE11/IE�NTAL CO'NSTRUC'fl®N LIEN LAIN My AV Y
DESIGNNER/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
commencing work or recording our Notice of Commencement.
Signature of Owner/.Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLOJUD STATE OF FLOl A o
COUNTY OF COUNTY OF a °A x
The forgoing instrument was acknowledged before me The forgoing instrumerlt was acknowledged before me
this day of 20 by this-\a day 200 by
�1�.� Ih�1,�c 9�, � ����� �cJf✓-�
(( ame of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Iden "fic Type of Id e 'fication
Produced Pio uced
A A DAWN D'AURIA N DAWN D'AURIA
rt �� ota y Public,State of FI r Go N
Commission No " lc)t al� � mission No. ��gblic,Stateof
Commission#FF 17015 Commission#FF 170158
My comm.expires Oct 20 2018 My comm.expires Oct. Florida20,2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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