HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMP`. =D FOR APPLICATION TO BE ACCEPTED' -
Date: 1 �2� Permit,Number:a\ir-�_?--O M
RECEIVED
FLO R1 DAf�iwBuilding Permit Application MAR 04 1011
Planning and Development Services Permitting Department
Building and Code Regulation Division Commercial Residential St. Lucie County
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: 'ino,1 o area n - C
PROPOSED IMPROVEMENT LOCATION:
Address:
Property Tax ID #: 3y�i� ^(b b 2 b00 "'z— Lot No.
Site Plan Name: T- 6 k12tAIIrZA L--. J151PVN'D A1N6-S C"1i170 � Block No.
Project Name:
DETAILED DESCRIPTION OF WORK:
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l� K�'rG `' �({ I R�IJa�-; � �AcE �1.� 1 b �'lz+�tay�'�b� I•V L.�g1-ft�Ns tro Kt+. MaJ: Swrrckys
AT f�Tt (i► -&} KrI-• ADg A(iwr �AmPS it, F3o-t4 13Atks • 1�tCJA<C6% DOBRS "'U?iM.Tk4t,61& LW
New Electrical Meter Second Electrical Meter "!&ceTl__fi&f_MCUT- l.twJ ef
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters Windows/Doors _ Pond
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ VOt 000 ..
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
OWNER/ ESSEE:
CONTRACTOR:
Name SG:10
Address: 6750 5- z5Pa.
Name: 4�4-o
Company: Pes(a)
City: _� CIO EA k*CS_f State: I L-L-
Zip Code::N al Fax: '
Phone No. 6:731 a7Z - S17 1
Address: q J W
City: I;r L.At.iState:�L
Zip Code: Fax:
Phone No I It 2600-Q,G�p
E-Mail l P05 iC.A (a7 • GD�✓l
E-Mail: �21 :7DLB Q QMArI L - N WL
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License c c.1250 702-
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
If value of HAVC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL -CONSTRUCTION LIEN LAW INFORMATION l
DESIGNER/ENGINEER:
— Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name: '
Address:
Address:
City:
City:
Zip: i Phone:
i
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 Counttyy 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 andj 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 paying twice for
improvements to your property. A Notice of Commencement must be recorded in the public records of St.
Lucie County and posted on the jobsite before the first inspection. Iflyou intend to obtain financing, consult
with lender or an attornev before commencine work or recordine vour Notice of Commencement.
Sig ure of -Owner/ Lessee/Contractor as Agent for Owner
Sign,qt6fe Contractor/License Holder
STATE OF FLORIDA,---
STATE OF FLORI,DA--
COUNTY OFjr-fl w o►
COUNTY OF
Sw�to (or affirmed) and subscribed before me of
Swor (or affirmed) and subscribed before me of
Physical Presence or Online Notarization
Phy i al Presence or Online Notarization
this�� ay of J ��rv1 ,-� 8 by
this 2_1 day of ,3-P���
�. 2byl
Name of person making statement.
Name of person making statement. �.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
L—
Type of Identification
Produced
Produced 7
(Signature of Nota P b ' - t
(Signature of Notary Public- State of Florida )
SANDRAVELEZ
- "��; : Nota pubNcaSSA of Florida
Commission No. ry
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Commission No. : r,�°'. �ti: Florida
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Notary P tc of
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