HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date:
as\�`� Permit Number:
z RECEIVED
Building Permit Appli atiOWN 2 _u);9
Planning and Development Services ST. Lucia County, Permitting
Building and Code Regulation Division �,.�
2300 Virginia Avenue,Fort Pierce FL 34982 �L
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential !`
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I PERMITTYPE:
Address: S LLAC__..1'0 ��• �� ���r3� t`�1aC,��, 1r_ 3 u R3_
Property Tax ID#: 3411 - SSO —7 Lot No.
Site Plan Name: Block No. —1 1
Project Name:
Milli! silllK K1�s
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Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank Gas Piping _Shutters Windows/Doors
—Electric _Plumbing r Sprinklers Generator Roof _ Pitch
Total Sq. Ft of Construction: °a- cQ Sq. Ft.of First Floor:
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Cost of Construction:$ 0 �O S o,o0 Utilities: _Sewer _Septic Building Height:
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Name Y UN(Nel e1_J,e kC! Name:
Address: I y:n ] Com-i`1"e
city: PDr�r Se'%A 3..e(Jk Stater, Address:l�"l 5 GtS Ali
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Zip Code: Z Y �( � Fax: City: P o C k' Se."At L. it— State:'R'
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Phone No. Zip Coder y( Fax:
E-Mail: Phone No'11
Fill in fee simple Title Holder on next page(if different E-Mail S('to tt\
from the Owner listed above) State or County LicenseC--C--0351 l`1 0 j
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
I City: State: City: State:
Zip: Phone Zip: Phone:
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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,l do hereby agree that 1 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
R LENDER OR AN ATTORNEY BEFORE RECO 1NGY_0_UAXQFKE OF COMMENC MENTI' —
Signature of Owner/Lessee(Contragtefas Agent for Owner Si ature of Contractor/License Hol er j
STATE OF FLORZDA STATE OF FLORI�A 1
COUNTYOF �Ir • Lac �� COUNTYOF
The forgoing instrument was acknowledged before me The foing instrument was acknowledge before me
this a. 'day of J y220'\"\ by thisa5rgoday of�,),n� 2011 by
Name of person making statemdrit. Name of person making statem nt.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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a F{1NNAP+IARIEGIVENS
{Signature of Notary P lic-State of Florida (Signature ofNoI ` tatn neV a
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Boll °d llvu Notary F4n!;.liiaenviia;s
Commission No. da ��" 1AR1t po2U'*a F�•`•
Dtl ,ea�)° ON �'G 2 p Commission No. a' )
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REVIEWS FROPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COU ,;° ' iE�iV REVIEW REVIEW REVIEW REVIEW REVIEW
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