HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE CO PLEFED FOR APPLICATION TO BE ACCEPTED
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Date:'" lD. Permit Number:
R #ry17wy— - RECEIVED
e, I MAR i 6 1010
Building Permit Application Permitting Department
Planning and Development Services St'
Lucie County
Building and Cade Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential —�—
PERMITTYPE:
PROPOSW"[t0UEMENT LT CATIONc
Address: IV'77 7 a'VAI e /ylr,� . fY. /irAce F� 3VOYS-
PropertyTax lD#: c23o9-YY3-001-000 2 Lot No.
Site Plan Name: // Block No.
Project Name: ultic/I f l e7Ge
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator' _ Roof Pitch
Total Sq. Ft of Construction: J 7 6 5•� ' Sq. Ft. of First Floor: .S 7,4 ti.T,r
Cost of Construction:$ 2 Z (/7-105 Utilities: _Sewer _Septic Building Height�r
OWNERjkESSEEt
C NTRAGTr�R
Name
Name: �rias e Ae-/A
�
Address: O/av/aP ✓il
Company: �irtrh %�e7J,
Lo
Xkie-
�M771
r7tis4,
City: , / i'PrG P /'4 3V7Vj State: ,5�
Zip Code: 3Ll9ri.5_ Fax: —
Phone No. 77o2- - 370- 3693
Address: 92VO
Ai,4sgr —rS
Zip Code: 3 ClGl •y q. Fax:
Phone,Nof • 77 a /6 "I3
/ai state:
a�/
FL
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail ,�i�^iern he Ae 4A o7yahro
State or County License C 6-6 --/S/g 72,
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.
P E EN t CON- TRUCT 0 LIE
FOR Ti s
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPA Y: _ Not Applicable
Name: �i
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
� �XfL-Z-440Z
Signature of Owner/ LessContfactof as Agent for Owner
Signature of Contractor/Licerfse Holder
STATE OF FLORID ``
STATE OF FLORIDA
COUNTY OF _In o , Cg p
COUNTY OF r s�
The forgoing instrument was acknowledged before me
this day 20_ by
The f r ping instru ent was acknowledged before me
lti by
of
this ay of 20a(
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
Produced
)tut
(Si ure of NEtary Public- StI& of Florida)
(S' n of Nota Fu -',S- tA0Pli611BS Nq 275U60
="' EXPIRES:December'12
�'F°r
Commission No. ,—
Commission No. L_.'.'_'' `" Bonded ThmN
LS:bl Uedervrdters
.a
;,°;?^--!��;, LASHAHNAINGRAM-RAHMING
_
+d;
EXPIRES: Decer
iber2O, 2022
REVIEWS
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PLANS
VEGETATION
SEA TURTLE
MANGROVE
REVIEW
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DATE
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DATE
COMPLETED
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