HomeMy WebLinkAboutBUILDING PERMIT APPLICATION1,
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: y SCANNED Permit Number:
M Lucie Cow*
I MINES Building Permit Application FEB 6 2010
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 �b1C,�
Address: r0-72.5 S mf e 4N 11*- / 1,, Dc 7_ Aof Z
Legal Description:
Property Tax ID #: � 11 &-az- / e, 91 - ® 0 0 Lot No.
Site Plan Name: l52ttbi'7_ Re5ra,�C0 Block No. /n
Project Name:
Setbacks Front /D� Back: f Right Side:",:> ' Left Side:
Name A-4-i r4 ,&
Address: k 67t t/79
City: \1e0,5'e -> State: fC_
Zip Code: 3 g96-7 Fax: _
Phone No,
E-Mail:
Fill in fee simple Title Holder on next page( if different
from the Owner listed above)
Name:
Company:e—
Address: a,-7v Sz )o
City: ASC State:zL
Zip Code: Fax:
Phone No. 7>Z- 370 `016
E-Mail: G'`i/Ae eeN/ZpQ' e_(y % ol, C'o"o-t,
State or County License: C�t� OS 7,
If value of construction is $2500 or more, a'RECORDED Notice of Commencement is required.
s�
DESIGNER/ENGINEER:
Name: Doo J - 4)e+.a,
Address:T/5:- GtA) Iyc
City: J ef P iT-e/L-
Zip:Phone:
Not Appf icable MORTGAGE COMPANY: ' _ Not Applicable
Name- e.4Cb*97r /V 47io v/q.r
�_f�� � I Address: S® K1/002elb S'% c,, j_17
State: C-- Cit S'(` �.
Zip Phone: _9- -? '��ate:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name: F BSI ,-r/e-
Addres : _7?5k!a S eplw AR Suj7v
city: S . 404xr' ��- I
Zip: _-KY,gRy Phone:
BONDING COMPANY:
Name: _
Address:
City:
Zip:
Phone:
_Not Applicable
I certify that no work or installation has commenced I rior to the issuance of a permit.
St. Lucie County makes no representation that is gran ing 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 Bu'Iding Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoinga full concurrency review: room additions,
accessory, structur s, swimming pools, fences, walls, si ns, screen rooms and accessory uses to another non-residential use
WARNfNG T 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 recording your Notice of Commencement.
of Owner/
STATE OF FLORI
COUNTY OF
The forgoing instr m�enVt/was acknowledge before me
this y 00)6e&W 20 -(7 by
1
(Name of person ackn
(Signature of Notary Pub)'c- State of Florida )
Personally Known 4*' OR Produced Identification
Type of Identification Produced
Commis o.'°% NAWY KATHY K, GATES
l ffAt�� �11 tale of FIt
_ " Commission# GG 104018
Revised 07/15/2014
Signal of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF —
The The forgo-'ng instru menkW_ji& acknowledged before me
this «ay of _. 20/7by
11
11
(Name of person acknowledging)
(Signature of Notary X/blic- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
KATHY K. GATES
Commissio IVY`` p°m ic, State of KIWAI)
_ Commission# GG 104018
My comm. expires July 17 2021
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INITIALS