HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date-1W SCANNED
+ Permit Number:
RECEIVED
• ___ �� 9 I i�i� P,F�P1�'�0
Building Permit Application APR 016 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
Permitting Department
St. Lucie County
PERMIT APPLICATION FOR: To Select from dro'pbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 3 , 1 "1f5n-Telm-'
Legal Description: ►�'t r&n n `F! 1C � Q on-e
1-�- 3 a c�ap�3^,a 12i �',
Property Tax ID #`:���1—c0' _0D C
Site Plan Name: G Aweq
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
n�-a I ► �a Y-,--kD CDe )e ram 'tA_)) 000 "P c�)2rVi c�
CONSTRUCTION INFORMATION:
Additional work to e e orme un er t is permit - c ec a app y:
F]HVAC 11 Gas Tank ❑Gas Piping Shutters Windows/Doors
KElectric El Plumbing Sprinklers ElGenerator F]Roof Roof pitch
Total Sq. Ft of Construction: S Ft.
Cost of Construction: $ "f Utilities:
First Floor: _
rarer 0Septic
Building Height:
OWNER/LESSEE: -
CONTRACTOR:.Inea
-I✓IaxM&
Name=' _ - = 1,
Named r� 5.
- -;
Address (�Q1r`J ��r.
Colnpan�r
ity C•V �-i ` 'l. State I_--
Zip Codec3R—
Phone o. 1
AtlEid.ress '� Iue�.� C
ity:� - Stater
Zip Code: U Fax:
ONO. —
�l
E-MaPee
p ,��I�e,
- l
Fill in simple Title Holder on next page (if different
from the Owner listed above)
E-Mai :
I
State o County License 1Y1
It value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
I
SUPPLEMENTAL CONSTRUCTION' LIEN LAW INFORMATION:
DESIGNER/ENGINEER:-, _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address: I
Address: "
City: I State:
City: - State:
Zip: Phone I
I
Zip: Phone:
FEE SIMPLETITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: I Address:
City: I City:
Zip: Phone: I Zip: Phone:
I
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 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.JA 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
corrjaTKcing work or rgocordinr Notice of Commencem
I
Signature of 0 ner/ a see/Contractor as Agent for Owner
Signature of Contra or icense Ho r
STATE OF FLORIDA I
STATE OF FLOR DA .
COUNTY OF '—V a, Q
COUNTY OF
The forgoing instrument was ackri wledged before me
The forgoing instrument was acknowledged before me
this day of 20_ by
this day of 20_ by
I
Name of person makinglstatement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
I /
4w�
J
/76..
ignature of Notary Public- 6to of F orida)
(Si t re of Notary Public- St a of Florida )
Commission No.Ik;RAM-BANNING
'r3 WCOMMISS"#GG275060
;A '# "EXPIRES: December 200 2022
Commission No. i;,, ., YASHAHNAINGRAM•RANMING
; 9r` . e:.;
f; :: W COMMISSION # GG 275060
:w
REVIEWS
•
FR I
ZONING
SUPERVISOR
PLANS
'
VEGETATIO
`d'RL?Pd 0�� 7bm
PyD k Und wAera
.
COUNTEII
REVIEW
REVIEW
REVIEW
REVIEW_
REVIEW
REVIEW
DATE
I
RECEIVED
DATE
COMPLETED
Rev. 8/2/17