HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ►-(
Date: 5- Permit Number:
may;.. a `.a�-s��-n-.��r-
MAY 0 2 2097
-- -
Building Permit Application
PERi:rlT I IiLG
Planning and Development Services 5t. Lucie County, Fl-
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:
PROPfJSED (NPRt3+,UEMiENT 1.®CAT'4N:
Address: SW m fq C
Legal Description:
Property Tax ID#: 9-/A=LOA (D10)-q 0C>0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DfT hLED DESCRIPTI®N 0I= WORK:
_Tit,CS`7 LL `/Yvy 152964S 7/Wo 9�� Ou7 I3
CONSTRUCTION 1' FQRMATION:
Additional work to be pertormed under this permit-check all t•at appy:
—Mechanical _Gas Tank —Gas Piping s: - _:shutters _Windows/Doors
./Electric —Plumbing _Sprinklers Generator _Roof
Total Sq. Ft of Construction: -.'Sq,Tt of First door:
Cost of Construction:$ �� Utilitie's.. .'Sewer. Septic Building Height:
s
OW'�ER�LE�SS,EE: CONTRA TOR:
Name < -
Name t,
Address 1'S I I �� JI . Company p!.! 02A PN E[ 4}�1\\C ✓V •
_ State: °AcCdress:, �n br 0
Zip Code°: � �q�l Fax: 'Citi: ...5 j-�-cCJ� State: '
'Phonef'No. 77a o2�d'P9o%`� Zip?Code:, . -F-ax
E-Mail: PhFone N6--) /-PR/0
Fill,inlei e-simple Title Holder on next page(if different E-Mail c(,o2/v p, UL>Ldp
from the Owner listed above) State or County License0�]
Evalue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
IJPPLEMEI�T ,L CONSTRUCT'ION LI �1 LAW IN'�O,RIUIP►1'ION:
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
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Agent,.,••�m�c Signature of Contractor/License Holder
STATE OF FLORIDA C o STATE OF FLORIDA
COUNTY OF C, d COUNTY OF
The forgoing instrument was acknowledged be f ena, The forgoing instrument was acknowledged before me
this day of 20_ b " -2 this day of 20_ by
ac y Cn
T
�
0=1
Cr
(Name of person acknowledging) o (Name of person acknowledging)
m
ti
(Signature of Notary Public-State of Florida ) = p_ = (Signature of Notary Public-State of Florida) °
Personally Known OR Produced Iden is ior' Personally Known OR Produced Identif a .•',0;
Type of Identification Type of Identification
Produced �o=o Produced �.o
9'3 ,C c n a,
Commission No. OQ 60�� (Seal H'x Commission No. ���06� (Seal) 3. s
.yam Cr
rn
7 n
C� T T d
REVIEWS FRONT ZONING Ufti�SR PLANS VEGETATION SEA TURTLE AIG
COUNTER REVIEW d\AE_1l REVIEW REVIEW REVIEW R61;&Mw
DATE
RECEIVED
DATE
COMPLETED
ev.