HomeMy WebLinkAboutBuilding Permit ApplicationSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not, Applicable
NJ e:
Address.
City: State:
Zipm 'h n e
FEE SIMPLE TITLE HOLDER: _Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _Not Applicable
Name,,
Address..
City: - State:
I p 1 .. ... Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT-. Application is hereby made to obtain a permit to do the work and installation as indicated.
1 certify that no work or installation has commenced prior t4 the issuance of a permit.
St. Luce Court makes no representation that is granting a permit wili authorize the permit holder to build the subject .structure
which is in conflict with any applicableHome Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association rid review your deed for any restricti ns rhi h 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 morns 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
improvementst aur property. A Notice of Commencement must be recorded and pasted on the Jobsite
before the first i ction. If you intend to obtain financing, cons y�I t wi lender or an attorney before
commencin� w ecordinja your Notice of Commencement,
Signature of C]�erj�Le�ee/Cgntractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF �
of Con, actor/License Holder
STATE OF FLORID I
COUNTY OF
The forgoing instrument was acknowledged b f r Thee forgoing instrument was acknowledged before ripe
this dad of - ��, �� .. b
this 'A day of 20 t by
}
Mame of person making statement
Personally Known OR Produced Identification �
Type of Identification `
Produced ��— l� � �� `�! I��IC�Z"
(Signature of Notary Public- State of Florida )
David Singh
Commission NO.
CC �1����- `JI�7TARY PUBLIC
a STATE OF FLORIDA
*; C GG0639347-
DATE
RECEIVED
GATE
COMPLETED
Rev. 812117
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
e
Name of person making statement
Personally Known OR Produced Identific ti
Type of Identification
Produced Ou C 2D
{Signature of Notary Public- State of F�
Commission €Va.L440
CC06�01'�
PLANS
REVIEW
VEGETATION
REVIEW
SES TURTLE
REVIEW
David Singh
NOTARY PUBLIC
MATE OF -FI.aR
corm# GG063932
Expires 1(281242
MANGROVE
REVIEW
ALL APPLICABLE FO, MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
11
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Building Permit Applicat�oh
Planning and Development Services
Building and Cade Regulation Division
2300 Virginr'a Avenue, Fort Pierce FL 34982
Phone: (77z) 462-1553 pax: (77Z) 462-1518 Commercial Residential
PERMIT APPLICATION FSR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION,
Address: V Ci
Legal Description: ]�i
Property Tax ID #: 3q I q. r 530 �=.9� Lot No.
Site Plan Name: Bock No.
Project Mame:
Setbacks Front Back: Right Side: Lift Side:
DETAILED DESCRIPTION OF WORK.:
- - - ---------
Aww%
4Z) %' ft, e �.-
I 15.5,e er, 0 Ton
CONSTRUCTION INFORMATION..
__
A itior�a work to e er orme under this perm a
et-�check� � apply:
E.
a.HVAC N has Tank ' Gas Piing Shutters � Windows/Doors
L=J Electric � Plumbing Sprinklers � Generator � Rood Roof pitch
Total Sq. Ft of Construction: SFt. ❑f Fiat floor:
v
dost of Construction: $ 9� � �, � Utilities: _ Sewer E Septic Building Height:
OWNER/LESSEE.- � CONTRACTOR.,
Name X i` L 01D N a r-n e: _ ��'`�"T
Address: Lq 0 6z V 1 %5 --1- (:-n� 12, 1L'rd Company: �i"-'IJE'�f ��f� L C
city:'Ts �- State: F f Address: qR& SW nlo I I V S+rra e �
Zig Code: 3L11?eF 3 Fax: CityState:
Phony Na �-� ��"�
- � 71�' � 2__ Zip Code: R L4!01 Fax:
E-Mail: Pone No, '7 `a 10 �
Fill in fee simple Title Holder on next page if different E-Mail: +r-ue,+_eno-vDLLV-.. (2-o qr-)nC_"` j . C'0A',
from the Owner listed above) State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. T w u