HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3� 3I LI� 60ANNED Permit Number:
BY
Si CQ,VCI'�'�iOUP�'C.v RECEIVED
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Building Permit Application MAY 07 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
Address: I c7t-f�T' � �r ) -i-f 1C i I(-u l
Legal Description: "t-';CJie,)"a�—'-t-�e�� L-D+
Property Tax ID #: QCDQ`
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side:
Permitting Department
St. Lucie Counts,
Residential o
es ' Or
Left Side:
Lot No. ,1
Block No.
DETAILED DESCRIPTION OF WORK: }
errs-r�Ce ro-t-2c� rc nS-�-er- 6"3i+ 'mil i cad
SIB Irk rn odu-I�5
CONSTRUCTION INFORMATION,:,
Additional work to be Pe,r orme un er.t is permit - check all apply:
F1HVAC 'Gas Tank ❑Gas Piping Shutters Q Windows/Doors
i
Electric ❑ Plumbing I Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ , UtilitiesInSewer E]Septi'c
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Nam ( n
Name:W I ohl lio n I1�
\`
Address:
j VP- ,
Company:
CitIn �sCl l IQe.il StatL.
Zip Code• 4x'11-ia.
Phone N v - ' 4A3 1.
Address: J
City: ` Stat :`-L
Zip Code: /I ax 31
Phone N
E-Ma' r✓.SK!l I +
Fill in a simple Title Holder on next page (,if different
from the Owner listed above)
E-M it
iYlCll
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN-LAW"I'NFORMATIQ.N,
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE,TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby madeto 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 resultfin"your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted onAhe jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or reo6rdinA your Notice of Commencement. /f
Signature of Own./ ntractor as Agent for Owner
Signature of o tractor/License Holder
U'�ssee/
STATE OF FLORIDI '�
STATE OF FLORID
COUNTY OF�
COUNTY OF
The i nstru nt a knowled efore me
thi 1 dayof 2by
The fo i nstrum nt sac nowled efore me
thisa of �20by
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U_1ML_tA'(
Name of p rs n making statement
Personally Known � OR Produced Identification
Name of Ngson making statement
Personally Known A OR Produced Identification
Type of Identificati n
Type of Identification
Produced
Produced
i ature of Notary P blic- State of Florida)
(' r of Notary Pubic- State if —Flo rida )
Co mission No. (Seal) ,
Co ission No. (Seal)
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