HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: S �� �� Permit Number: 11cs-
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RECEIVED
Building Permit Application
MAY18 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:
PR®
ME,ED IN'PROVEMENT
Address: 3 6.q 0 Soo- -h 2-54 St -T o:>r " P I eY Cc, T-- L, I( 9 g 1
Legal Description:
Property Tax ID#: ':P1 )— CUD)— 1 3 iO4 Lot No.
Site Plan Name: Block No.
Project Name: b0�:C'0&`7%%
Setbacks Front Back: Right Side: Left Side:
DETA�II_ED DE�S':CR�IPTION OF 1NOR'K:
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Additional worK to be pe orme un er this permit—checK all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: lid�'� Sq. Ft. of First Floor:
Cost of Construction: $ j s O Utilities: —Sewer Septic Building Height:
OtiNN�E�RJLE�S�S'�E: C��ONTRA�TO'R:
Name G' rl r �7C��i Name: Hit' `` C4
Address: lO C� pZ5 �/ Company: ID 2 I s�' .13 ` tOY'
City: State: ' Address: '?,i(,40 W q��
Zip Code:3Kg/ Fax: City: %IY,(�'��l State: f"(-/
Phone No. 77d- 5 77 5/3)7 Zip Code: 33 1Z Fax:
E-Mail: Phone No (T�ia-�fy
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU` yPLEIUIE=N 1 1 toIS)I R±UCTION LIEN LAIN IN:F®RIIUTATI®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 thepermit 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/Les4e/Contractor as Agent for Owner Signature of Cont y
ct Picense Holder
STATE OF FLORIDA p STATE OF FLOR A
COUNTY OF `i COUNTY OF
The forgoing instrumq wa acknowledged before me The fo�&oing instrumen was acknowledged before me
thisday of 2Q�by this '� •4'day of All/ 20' by
O� �7
(Name of person acknowledge g) (Name of person acknowledging)
(Signature of Notary Pul I' -State of Florida) (Signature of Not y Pu lic-State of Florida)
P sonall Known ce a
Personally Known {� O P���d Identyjjj CICU Y '04, a ` , 8RUZ
Type of Identification MY COMMISSION#FF997 0 e of Identification +'t
Produced = '''
Produced MY COMMISSION#FF997102
EXPIRES July 09,2020
.,tiRF1 PIRES July 09,2020
I407)398-0153 FloridallotaryService.com (d07)398.0153 F arySemce.com
Commission No. ea ommission No.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014