HomeMy WebLinkAboutBuilding Permit Application6o Ww7"O�
u All APPLICABLE INFO MUST BE CUivir-LETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:. 06 1 a. - 010
RECEIVED
Building Permit Application DEC 3-11010
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 st. Lucie county
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: %E(a�
Legal Description:
PropertyI/ /z
Site Plan Name: 4!';0 / Block No.
JF
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Setbacks Front Back: Right Side: Left Side:
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_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Y Electric Plummbing _ Sprinklers — Generator
Total Sq. Ft of Construction: I/V0 Sq. Ft. of First Floor: _
Cost of Construction: $ 47'ya 40 000 Utilities: _Sewer _Septic
Add
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Zip Coder_5��-,F ax:
Y�
Phone No.
Zip Code:.
E-Mail:
Phone No.
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or G
Windows/Doors
— Roof
Building Height:
0
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
u Ii `YI li S• �,{Ui Y 1
DESIGN / NGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applica.ble'
Name' .CJ Name:
Address / Address:
City: State: City: State:
Zip: hone Zip: Phone:
I ;
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 ma-y, resttict�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, perforrim_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 firs inspection. If you intend to obtain financing, consult vy�th 17der or an •att9rney-before
rnmmpnrinp nrk or rpcordinh vnur Notice of Commencements, //
rSignature i5fi0 nt/ Less /Contractor
Signat &of o ra or/License Holder
STATE OF FLOR A
STATE OF FLO I -
COUNTY OF e.
COUNTY OF
The forgoing instru nt was acknowledged before me
this 1 y of 26 9py
The forgoing instr nt was acknowledged before me
this/D day of , 2Q Z y
u Ae �✓
(Name of person acknowledging)
(Name o erson ack wI dging )
(Si a l�ic- State of Florida)
(I nature of Nota tic- St of Florida)
Personally Know ►� OR Produced ldentification
Personally Known " OR Produced identification
Type of Identification SLebeCCa pima
Type of Identification
Produced ���11111� t;G06087
aYP„
Produced �� _`B�. SHERRIFEHLMAN
#
Commission No. _ = �lfaS• -ts ailn �pfaq�
Commission # GG,18716
Commission No. xpires March 14, 2022
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