HomeMy WebLinkAboutBuilding permit applicationAll APPUCABLE INFO MUST BE COMPED FOR APPLICATION TO BE ACCEPTED
Date: 0) X 0 Permit Number:
Planning and VeVe1&prncnt.ServicLrs
Building and Code Regulation Division
2300 i inra Avenue, Fart Pierce FL 34982
Phone: (772) 462- Fax: (772) -1578
Building Permit Application
PERMIT TYPE: S/4 D Ce3t
Commercial Residential,
a4 --
Address: A._.'Te4 A. vc r► e�{ �G�d- � � L.�C4�3 �� I �.3
Property Tax ID Lot a
—L ?_..
Site Plan Narne: Block No. 4157
P roject N a rn e:
1190 0 ru Loop r),e,
ddi i nal work to
be performed under this
permit –check all that
apply:
Mechanical
— Gas Tank
Gas Piping
, Shutters indows Doors
Electric
Plumbing
Total - Ft of Construction: 0 13
Cost of Construction: S0
prin klers
State;
Zip Code: �_'� 98� Fax:
Phone No. 963 3.)
E -Mail:
Generator
€ . Ft. of Fist Floor.
Roof Pitch
w e ra epfic., ..� J , fight:
F
arp e
Company;
4wrjapmf 2"
Address. I t/T'
Zip rode. 3:!�O 2
Phone No
Fill *In fee simple Title Holder next page ( if different I E -Mail
'from the Owner listed above)
4
State: �
Fax:
Yo— S—
State or County License CS E /5'
If value of canAmon is $2300 or more, a RECORDED Notice of Cornmencement'is required=.
If value of ,SM or more, a FtECOR DED Notice of Co rr~mencement is req U1red 0
, 1.90
DESIGNER/ ENGINEER: Not ApplicableMORTGAGE COMPANY. Not Applicable
Name:Name:
Address; Address.
City. State: city: State
Zips; Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: � Not ApplicableBONDING COMPANY: Not Applicable
Name: Name.
Address: Address:
City. City:
Zips Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFI IT: 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 nc repryentation that is granting a permit will authorize the er .it holder to build the subject structure
which iin conflict with an applicable Home Droners Association rules, bylaws or an covenants that may restrict or
pro .
ibit such
structure. Please consult with your Hoe Owner cciation and review your deed for any rhich��apppy.
In consideration of the granting of this requested permits I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans., the Florida Building Crudes and St. Lucie County Amendments,
The following 'building permit a pp lirations are exempt from undergoing a full concurrency preview: room addition $,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
"WARNING TO OWNER'.* YOUR FAILURIE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYINC
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECO I ED AND
POSTED III THE JOB S BEFORE THE FIRST INSPECTION. IF TOLS INTEND TO OBTAIN FINANCINC, CONSULT
WITH YOUR LENDIER OR AN ATTORNEY BEFORE RECORDING YOUR N TIE OF COMMENCEMENL"
Signature of Owner/ Lessee/Contractor as Agent for owner
STATE OF FLORIDA
COUNTY OF
The forgoing ins3ru ent w s acknowledged before me
this,53 day of 20QLO by
I
amey"erson making statement
Personally Known
Type of Identification
Prodwc r
R Produced Identification
O�
so@ Ise
d� +� , I
f i;L Ik
r'e of Notary Pub hc-State of Florida- j
Commission Na.�Qw :P (5eali
Signature of Contractor, License Holder
STATE ESE FLORIDA
07tok,rz.
COUNTY OF a
The forgoing instrument was kr�owledged before me
this � day of ,%%lfl �. 20_00 by
a, * e 9VArson 11� � aVi g' statement,
Personally Known vo'� OR Produced Identification
Type of Identification
Produced k Z
IF
iSignaf��(VNatary PL
Commission Na.05;�4ea
Sea Ij
VIEW. FRONT T III U PE I R PLAINS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW RE' I EW
DATE
RECEIVED
DATE
COMPLETED
et