HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �
Date: 1� Permit Number: 11
12,- o
17d l'
•
Building Permit Application DEC 0 4 2011
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 APPLICATION FOR: To Select from dropbox, click arrow at the end of line 1� 1.6_rn -S-C R J
Address: 1,S1 KZA-le,�'' 11
Legal Description: &:y ►t; ge, 404 "1 CD�, &Q-21485
Property Tax ID#: �l.S�l'-Sf�3-a�10'd�X'i—� Lot No. i
Site Plan Name: / Gk40Y%eY\ Block No.
Project Name: &*_
Setbacks Front 01A Back: _' Right Side: O Left Side: 10 '
(AdintG'(fi°n S'iYit Se4y-.eh �RC'%15Wti°— G.1� �{luw�;.+�,ti. '�e0.a,.� �..R.Ei l�Jc7-t' a•�
a c cre�2 StAb .
�` �ws Se r ce--N % c* Sam[ ,1.� l-(uCT�ca+ .2iN�
L:IHVAC
11 Electric
QWindows/Doors
0 Plumbing [] Sprinklers Q Generator 11 Roof Roof pitch
Total Sq. Ft of Construction: —300 S . Ft. of First Floor:
Cost of Construction: $ 12, 260 ' � Utilities: Sewer [j Septic Building Height: 16 ' pgr=L,
blllNERLE�l:,
5'�y, tJL
F}��� ��,.
.. .f�l""31 �"'#`g r`�".F gfi°..� {
�CCINTRACTtR
Name Rob" I. L,-,tifineag
Name: Ru6eM, 4-.r
Address:../1 /ny&eete- Lc,��r
�-F• 7_✓V'
Company:�4z�ot,3
City: y�TUnSP.v► gC&'11 State: �
Address: .9 (4-A(ir&
Zip Code: ftLlA.,� Fax:
City: �c'�-5� . Lvc,L -
State:E/._
Phone No. qil!A lifoQi 661r l
Zip Code: -1110 �'� Fax:
=--• ?_ S,7'4 i'o2kD
E-Mail: �D r]� r S'% wA C OINCO's -'r . iJ �.�-
Phone No. Qp Wt
Fill in fee 'simple Title Holder on next page ( if different
E-Mail: l�ubc n, �.b���► • LI-� o
c-Oq►ti.d, 1. erAm
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
{
SUPP:EI�lENTAL CONS,TR LAtNORM
ATlONIN
�r�l'ION,LIEN
k Y2 f.
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: J Not Applicable
Name:Swl QardloAy ('am
*CoC�
Name:
Address: Qg7 - ,ALb&t4 SkAim
0r• UY0 bj
Address:
City: h
State: P1.
City: State:
Zip: Phone A(3
l88 S3'N
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Z 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.
1 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 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
commencing work or recordingyour Notice of Commencement.
4
Signature of Owner Lessee/ s Agent for Owner
Signature o Contract )cense H I r
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Sa . Luc. L
uG
COUNTY OF S I • L+�
The forgoing instr ment was acknowledged before me
The forgoing instrument was acknowledged before me
this I day of 1aLEZyv►bCr , 20—Lq by
this (_ day of ,t7t1S2-+b-� . 20_!—q- by
Name of person