HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Numbe�»3J
RECEIVED
MAR 12 1011
' Permitting Department
Building Permit Applicati®nst. Lucie County
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772)462-1578 Commercial Residential `�/
PERMIT TYPE RART�\
�a
.
Address: q 0 S Al. g2PU h SM15e r 0-Ce f✓ -3 L19 W7
Property Tax ID Lot No.-S,Y La cJ
Site Plan Name: Block No. ALL Lam(P
Project Name: �k
i tF
�-Mr.
Additional work to be performed under this permit-check all that apply:
j _Mechanical _Gas Tank _Gas Piping ^Shutters —Windows/Doors
_Electric _Plumbing `Sprinklers —Generator _Roof Ritch
Total Sq. Ft of Construction: H O � Sq. Ft. of First Floor:
Cost of Construction: $ -3 9 C1 J Utilities: _Sewer —Septic Building Height:
- s=
Name C Name: -
Address: 14o ��, Ll S�Y" "Company:
City: 7
� (i, � t ee-Ca_ State: F L Address:
Zip Code:-3 i4 C1 q`7 Fax: A City: State:
Phone No. �Q2,II'�d�� Zip Code: Fax:
E-Mail: �� rLYSO&Zf3 Gl d'D. (6r/) Phone No
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County License
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.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: ,Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
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, 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 IIy YOUR PAYImG
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE .SOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Own / essee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
I COUNTY OF S�•tV c•ce COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this d• day of T-f\41( ,20a` by this`day of 20_ by
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
(Signature of Notary Pub c-State of Florida ) nature of Notary Public-State of Florida }
NNAGIVENS Ida
Commission No. dt eal) rJt State°t FloCo mission No. (Seal)
pubsi��FiH OaZ8,1025
a:°:N "<: Comm ices fan Assn•
REVIEWS FRONT OFiVC6ondedt
SOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
I