HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE 4NFO:M1UST BE:COMPLETED:FOR APPLICATION TO BE ACCEPTED
Date: ISI 311 Permit Number:
diij
Building Permit. Application MAY 0 3 2011
Planning and Development Services PERM11TTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772).4.62-1553 Fax:(772)A62-1578 Commercial I Residential
PERMIT APPLICATION FOR: To.Select from dropbox, click arrow at the end,of line. U
PROPOSED MPROVEMENT LOCATION.
Ct1. ,. .
Address:,, �J � GTGi�i - vqv
Legal. .e�criptio� i LK,3S L..O T 19 (Me, 3� Zrnl (09, 3�'f Z—
22`I
ci
4ISVOyQZ 1 _ tProperty Tax.ID:#:
NO.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
J�DETAI L-ED-DEKRI PT1OV OF°WORK:t'` ..
pr l�c.-e q toy, pr)C 3 ys+ n J L4 S e
Like
1.CQNSTRUCTION INFORMATION:
Additional work tobe nerformed under tispermit-.check all thatapplV.
[&VAC Gas Tank Gas Piping _Shutters (�Windows Doors
�. I_l Windows/
Doors
Plumbing Sprinklers Generator a.Roof Roof pitch
Total Sq. Ft of Constructioinr:2S Ft.of First Floor:
Cost of Construction:$ '? )� . CIO Utilities: Sewer FISeptic Building.Height:
OWNERAESSEE:' CONTRACTOR: 3
Name Name: U2ru
Address:119 SW Pry e_ Company:�1
City: P i_ Stater Address: WL44YVIorc. I, C _
Zip Code: �Er3y 0 Fax: City:PS L... State: r'L
Phone No. l 3`111 S Ll 3 Zip Code: 3 9`4 Fax: .
E-Mail: Phone No. 2- 12- 32_02—
Fill in,fee simple Title Holder on next.page.(if different E-Mail: rk L&A 01 U 6 C e • +S 0( • CO
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION:LIEN LAW INFORMATION':,
on
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 BONDIN.G.COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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,Kali 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
commericingwork or recording your.Not' a of Commencement.
Sigh-Jlt&P6 of Owner Lessee/Contractor as Ag t f r Owner Signature of Contractor/License Hol ed-r
STATE OF FLORIDAcc STATE OF FLORIDA
COUNTY OF L� �,c C COUNTY OF
5j- Lut C a t
The forgoing instrument was acknowledged before me The ffoorg9ing instrument was acknowledged before me
this day of 20 nby this JILDIday of 20 (1 by
(Name.of person acknowledging). (Name of person acknowledging)
V
( ignature 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 Identifica ' n Pro uced
TvDe of Identification Produced
C�3 S .P� KAREN D.CHIS OLM
Commission No. l 11�f ate MY COMMISSION# F<J991i sion No -I '13 S ppm KAREN D.CH OLM
EXPIRES:MAY 1 ,2020
�? `� MY COMMISSION FF994356
EXPIRES:M 1,2020
�w Bonded through 1st S
Revised 07/15/2014 e Insurance
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS