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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COIVIPLETECi-FOR APPLICATION TO BE ACCEP Eu
Date: �' Z Permit Number:
SCANNED
BY
RECEIVED
St Lucie County
FEB 07 1010
Building Permit Application
Planningand Development Services Per i t'n Department
p ,��i��sOM
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: CfinL�% }- �
Legal Description: -31 a Lfil/f%S� �4J1�Si�e�JIU Jt�� 5 �/-5 /mot F/ � s u -6
rty�Tax1!Q�#: a / 2_ 9 - 7dLot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side:" !2- B Left Side: '/ : l�
DETAILED DESCRIP ,. CIF WORK.=; $'
e
�r
r e itch A,
re 00 ®ur'i L'o�� -
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CC1,N5TRlJCTION INF©R ATIO
Additiona I work to be performed un er t is permit -Check a tat, apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 1 Sq. Ft. of First Floor:
•ost - Construction: S '71rO0. Utilities: Sewer Septic Building Height:
Pl_i^nni-rn.w.r�=rn�. `
X_a me ► Y LOLY1 (om[ C:_
Name:
Address: 3. h / r( 1q,5.5,kz--7Yl ca�
Company:
City: d !'ice P t!!- State:,
Address:
Zip Code: �1��_ Fax:
City: State:
Phone No.gv �'/
Zip Code: Fax:
E-Mail:
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.
i
�SUPF��E IENTAL.C�tdIUSTRl3CT C (V UEl' "LAW, 3R IATIU •b } a a `� �
t
DESIGNER ,ENGIN ER: _ Not Applic ble MORTGAGE COMPANY: Not Applicable
Name: G �p ncri 1 Name:
Address` 03 tD Address:
City: Ap I State: City: State:
Zip: Sjq. ,* Phone �R Zip: Phone:
I
FEE SIMPLE•TITLE'HOLDER:
Not Applicable
BONDING COMPANY: Applicable
_
Narrie: " " ` ' '
_Not
Name:
Address: I
Address:
City: I
City:
Zip: Phone:
Zip: Phone: I
I
OWNER/ CONTRACTOR AFFIDVIT: /application
I certify that no work or installation has comm
is hereby made to obtain a permit to do the work and installation as indicated.
enced prior to the issuance of a permit.
St. Lucie County makes no representationat
which is in conflict with any applicable Ho
structure. Please consult with your Home Owners
is granting a permit will authorize the permit holder to build the subject structure
Owners Association rules, bylaws or and covenants that may restrict or prohibit such
Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requlested
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
accessory structures, swimming pools, fenc
WARNING TO OWNER: Your failure to
exempt from undergoing a full concurrency review: room additions,
s, walls, signs, screen rooms and accessory uses to another non-residential use
Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Niotice
before the first inspection. If you intend
commencing work or recording your
of Commencement must be recorded and posted on the jobsite
to obtain financing, consult with lender or an attorney before
Notice of Commencement.
Az��i 1
gpeof O heri`/JLessee/Contractor as
Agent
Signature of Contractor/License HolderSTATE
OF FLORID - , .
COUNTY OF
11A:;1
STATE OF FLORIDA
COUNTY OFThe
I by
for oing instr t was acknowledge�befo
this day of 20
IV
The forgoing instrument was acknowledged before me
this day of 20by
Name of person making statement.
� �N
Name of person making statement.
a
Personally K OR Produced Identifica
Type of Identificat' /n\
Produced l/" r �•
p
l�
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Nota ublic- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
i
DATE
RECEIVED
DATE
COMPLETED
Rev. 812117