HomeMy WebLinkAboutBuilding Permit Applicaiton All APPLICABLE IN�/FOO MUST B(E�COMPLETED FOR APPLICATION TO BE ACCEPTED [ 9 0 (n
Date: ��� CO u Permit Number: `�
..... ._. . .. r. Building Permit Application Z ar�me
per SttiL�9 County
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:
PRapOSED'IN"PROVEMENT LOCATION . Y
Address: 6-14 406 L ��- OUd � • 1� .rts
34-
i SZ
Legal Description: t_i, f> Ak f' c�Nu�rm � r� �PQ�(U-3�> ��, a3 k,4 7;
r
Property Tax ID#:AMQ_—fib 7 6-el-7 666 "' Lot No.
Site Plan Name:L .ititLs ai SiAL4At4a-4, Q&JT , Block No. 33
Project Name: �� u�-
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION CIF WORK
C(7NS,,RL),C °,INFQRMATION
. _ -ti�a
itiona work to be pertormed under this permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator V"Roof Pitch
Total Sq. Ft of Construction: 1F66.�'(-A,—, Sq. Ft. of First Floor:
Cost of Construction:$ � Utilities: _Sewer _Septic Building Height:
ouuNER/LESSEE. CONTRACTOR: }
Name�2rati. 4,A Name: LANI a It
Address: t oL4.: wb(L. e,4 _ .. Company:(0, (,hA4L, .�J< CIL ) ��c„c 7U
City:(PO A� " � State Address: r 1/Lt L 6W af-
Zip Code: '�`F�'t (S 4 Fax: `- City: Stater
Phone No. Zip Code: 1F�'i J�;L Fax: .�72-
E-Mail: Phone No '7 Z Z '— ;?>'76 —,!�-73 5
Fill in fee sim,'ple Title Holder on;next page(if different E-Mail C'y'tCCC CGS `7'272 ,�]c��, �r�
from the,Owner listed above)' . J ::'= State or County License�/�(�f,L����Z3�
i
If value of construction is`2500`or more a RECORDED Notice of Commencement is required.
SU.pPLEl1/IENTAL CONSTRUCTION LIEN LAIN INt, RMATIQN
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
commencin rk or r9ording your Notice of Commencement.
IW41,1)
60aru
r f 0 er ssee/Contractor as Agent for Owner Si Lure of Cont t /License Holder
STATE OF FLORID STATE OF FLORIDA /
COUNTY OF � (J .(-( � COUNTY OF 0a
The forgo,IIng instrume t was acknowledged before me The forgoing instrument Was acknowledged before me
this-S day of L 20TL by this_Yday of l(„/-_204 by
(Name of perso acknowledging) (Name of person acknowledging)
PA
(Signature of Notary Publi -State of Florida ) (Signature of NotarOublic- lorida )
Personally Known OR Produced Identification Personally Known ° '-d-Identification 3HN
Type of Iden ' 'c tion Type of Identification 3rY Pub is
Produced Produced % �,�o;? 27007
expires
2022
Commission No. ��11A'p' ELLENsV& GHN Commissio
to of Flor da-N9otary Public
kE Cbrr)mission # GG 270079 e` Ccs, n + Public
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'+ist,r,: .Sire
nn+ Gotobar.22, 20 .
REVIEWS - - OR PLANS � 11R-T- 41EVIEW
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COUNTER REVIEREVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED ,.1;YP�• ELLEN V UGHN
DATE '* Commission # G 270079
COMPLETED P,�r my Commissi n Expires
ev. 7/2014 October 22, 2022