HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED C
Date: Permit Number:
11G2
Building Permit Application p erh/,, 970,.�
Planning and Development Services SF<�c90ep
Building and Code Regulation Division PCIO '�7'nl
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial t VResidential
PERMITTYPE:
MPOSED WA M UNS&W LOC "-
Address: L()L N
Property Tax ID#: 7 2V0 DC00 Dib-- Lot,No.
Site Plan Name: Block No.-
Project Name:
DETA LEAD [TES C«R+IPTtO UE 1NOR
L.cLX>'-J
CONSTRUGT)ON 1NF0� ATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing Sprinklers _Generator X Roof L Pitch
Total Sq. Ft of"Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Ga I- D� Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 5-C- LL LC:C(e Name: �'i ls✓1�► C GI
Address: Z72,?Tib Company: u�-
City: (�Pir?yh� .State Address: 37�Z L ()L-s fir✓
Zip Code: 3q -Zg-2, Fax: City: Q.ca2e � State:(_
Phone No. Zip Code: 5ESIRz Fax:-J'17
E-Mail: _. ...r._ Phone No •772,2L(-,•—S10Lk7-7
Fill,in fee simple Title Holder on next'page(if different E-Mail ca s
from the Owner,listed above)" State or County License 666 OS-S-S-1 D
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.
E 57R CTIN O
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
�z
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: i Name:
Address: Address:
City: City:
Zip: Phone: I ± Zip: Phone:
I
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 applicabJe Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Qwners 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 OWN FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY ESULT IN YOUR'PAYING
TWICE FOR 1 ROYEME TS TO YOUR PROPERTY. A NOTICE OF COMMENC NT MU T BE RECORDED AND
POSTED O THE JOB EFORE THE FIRST INSPECTION. IF YOU INT O OBT ANCING, CONSULT
WITH YOUfiXENDE R MEY BEFORE RECORDING YOUR NOTI O C Er4 EMEN
FAf/
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor License Holder
STATE OF FLORIDA C1f STATE OF FLORID
COUNTY OF Jc - COUNTY OF
The forgp'�instrument was acknowledged before me The forgoing instrument was acknowledged before me
this - 4Yday of I&V A _ 20A by this -�-Way of r 9 20J4 by
skl C0JW.q 0 Cu-, 5' � t�VC
- o�s5 !l0 a
Name of person making statement. Name of person making statement:
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced - L Produced FA_)0
(Signature of eQ§t (Signatur of Notary Public-State of Florida)
J ��`"YpV/,/ ELLEN VAUGHN
Commission N .�=°s� e`�_State of Floridayfcl@t�fy Public Commiss �2� YP�B; (Seatma
-* fission # 70079
P M Commission Expiresy to rublic
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REVIEWS FRONT ZONING SUPERVISOR PLANS 10J EA1A0A2E. ANGROVE
COUNTER REVIEW REVIEW REVIEW RE R REVIEW
DATE +° p`a�=
RECEIVED = .= tate of IFN V
DATE °����°P`O` m s ion NG ry P,",
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COMPLETED y CoC mi Gi
ev. er 222X22 Aires
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