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All APPLICABLE INFO MUST BE COMP. - 'iD FOR APPLICATION TO BE ACCEPTED
Date: // 6 /� Permit Number: 1 lJy�
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Building Permit Application NOV 0 6 2010
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie county
2300 Virginia Avenue, Fort Pierce FL 34982 -,
Phone:.(772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
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Address: -
Legal Description: Q Jnl�rl, 1�!'
Property Tax ID #: 1 el3l ' �96 c5_i - 00D ' 9 Lot No.1_
Site Plan Name: AA �/_� �,S Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pertormecl un er t is permit - c ec a t at app y:
1/,_Mechanical _ Gas Tank Gas Piping ,Shutters ,/ Windows/Doors
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c Electric Plumbing _ Sprinklers . _ Generator -"Roof>Z Pitch
Total Sq. Ft of Construction: % �9 r] Sq. Ft. of First Floor:
Cost of Construction: o Utilities: -Sewer ✓Septic Building Height:
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Name mow► LN,. H4•HS Name: +
Address: 206 Company:
City: 4W. Statefz�L Address:
Zip Code: Fax: City: State:
Phone No Z7LJ a16 `466 FY Zip Code: Fax:
E-Mail: Dom, iu' o ` 20D i - & 9 9 P.��o�►.�Cr°"1 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.
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DESIGNER/ENGINEER: Applicable y
_Not MORTGAGE COMPANY: _Not Applicable
Name: Nariie:
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
is in Home
which conflict with any applicable 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
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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 first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencint work or recording our Notice of Commencement.
i
i ature of Owner/Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
'STATE OF FLORIDA
COUNTY OF S�- �„�( A -
COUNTY OF
The f ygoing instrument was acknowledged -before me
The forgoing instrument was acknowledged before me
this UD day of Oq. , 20-Lk by
this day of 20_ by
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- State o Florida)
(Signature of Notary Public- State of Florida )
Personally Know roduced Identification L' DL-
Personally Known OR Produced Identification
Type of Identific iopmm,,, ELLEN
l'pY PV �i
e4o'cSta
Type of Identification
Produced c:° a-NVAUGHN
otary Public
Produced
Commission # GG 270079
Commission No. �,°°;;;QMy Commis Qalj:xpires
ctober2,
Commission No. (Seal)
2022
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