HomeMy WebLinkAboutBuilding Permit Application � I
All APPLICABLE INFO
MUST1 BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: c�--\' \ Permit Number:
h # RECEIVED
�► APR 2 9 2011
® Building Permit Application
I'Qrmitti.;g Department
Planning and Development Services Sc. Lucie Coui7ty
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 j
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential 'k
PERMIT TYPE:
Address: ?L<- �-, Cg5
Property Tax ID 4: 062C2 2 Lot No.
Site Plan Name: Block No.
Project Name:
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Additional work to be performed under this permit check all that apply:
Mechanical Gas Tank _Gas-Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator X Roof V'Uk Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1z ee&' Utilities: —Sewer —Septic Building Height:
y
Name �o Name: CC670&�
Address:. PIS Company:I'ASNct LLC-
City: -4:-i State: Address: .3'2-Z t AU
Zip Code: ,3LJ9F('2- Fax: City:f PIEe�e State:Fcr
Phone No. -7-1Z $�O( '135A7 Zip Code: Fax:
E-Mail: Phone No '77Z 21(6, -R'Dff-?
Fill in fee simple Tide Holder on next page( if different E-Mail �f btu 3e Lta�n
from the Owner listed above) State or County License� � /D2fi�i
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.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Y 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 IN YOUR PAYING
TW9CE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON T .90B SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBT ANCINC, CONSULT
-WITH YQAJKE E3,09_jANATTORNEY BEFORE RECORDONG YOUR NOTOCE O ENC ENT."
Signature of Owner essee/Contractor as Agent for Owner -Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 15� J QLJ-e_ CQUNTY OF S4: Uxl
The for i L�g instrument was acknowledged before me The f r ng instru ent was acknowledged before me
this day of A- l 20� by this d fk ay of l-�rl1 2(DI by
W 6 cve, Cd-
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Knox OR Produced Identification
Type of Identification Type of Identification
Produced Produced
gna ure of c Public a of j;or a ) CATHERINE"'ENEZT(Snailsre�fNotary Public St e Florid ) CATIIERINEJIMENE11 khe`" m� Notary Public,State of Flor � °a Notary Public,State of FI riCommission No. "1 'A L Seag0mmission#GG92121 � _M Comm.e+ October 8, sion No. >1 SeXl mmission#GG9212 3
Mycomm.expires October 8 2 3
REVIEWS FRONT. ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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