HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: .���� 2 Permit Number: l
RECEIVED
NOV 2 9 1011
Building Permit Application Permitting Department
Planning and Development Services St. Lucie County
Building and Code Regulation Division Commercial Residential
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 CBDG Funding
PERMIT APPLICATION FOR:
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Address: ?off. 4-0 rL-7+ b4 %,0 f� l
Property Tax ID#: f'�-�, � ��- (� p Lot No.
Site Plan Name: Block No.
Project Name: &VA J t> i ej L.F_ C-0 A b V AA 14 1 V 'W%
RE 2 air= J!>lZ.o �oS�l^��51 0 Q <' AP L.�
New Electrical Meter Second Electrical Meter (Affidavit required)
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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: Sq. Ft. of First Floor:
Cost of Construction: $ A- R ��/' Utilities: —Sewer —Septic Building Height:
Name WLA-11) ISLE C-c)-1 O AsSc>C. . Name:
Address: 3770'A Au. 14--4y 6 i A Compan • Ge,6rz4(, BLt>e, SyQ✓lc�G
City: t E(.LC_E State:_rL- Address: 1?�Rc>), 19'G►R
Zip Co :a wi-)Fax: City: C 4 c.L 4 4 A J State:__V_j,
Phone No. S E- Zip Code: 3,2,C>► 1 Fax:
Mail �SM�a�L� ELLS®T/�ER2r�L- •(AAA Phone No SL I • �La $S 3
Fill in fee simple Title Holder on next page (if different E_MaiIAA LA14IZ51 M,%I L. LoM
from the Owner listed above) State o County License r-.4,4- 0 5 9-(i 4 S
` 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.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: G6 M L 4.1--C Name:_ A)/!a
Address:, -5W nc_F_ ,J BL_V ,). Address:
City: .-v a R.,— State: [- City: State:
Zip: Phone �7�• 2 gyp_! (, Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: _�J/A Name: 4)/r3-
Address:Tr 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 conflicts with any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with our Homeowners Association and review our deed for an restrictions which may apply.
Y Y Y Y
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. If you intend to obtain financing, consult
with lender or an attorney before commencing work or recording our Notice of Commencement.
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Si ature f Owner/Lessee/Contractor as Agent for Owner
STATE F FLORIDA
OU OF /
Sworn to(or affirmed)and subsc ibed before me of v Physical Presence or Online Notarization
this day of 20 Zl by
aJ
N e of person making statement. /
Personally Known OR Produced Identification
Type of[den 'fication Producedb�VW,i L4C.IC.'s-&,
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(Signature of Notary Publ c-State of F rida) LAUREN HARDY
u` p���Pa r`r° ���Notary Public-State of Florida
Commission No. W o `L (Seal) ®o Commission# HH 85097
lvFy Commission Expires
January 26. 2025
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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