HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED rUK APPLICATION TO BE ACCEPTED `VV �j�/- �` ?C.�
Date: Permit Number: I nUCp �u�v I
,r SCANNED RECEIVED
BY JUN '2 9 2010
linii Sf. I UcJ.- rounbv
Buirding Permit Application permltting Departm@ir
Planning and Development Services St. Lucie CpuM
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:
Address: 1169 S� i �L� a�s?4 T ��% sT �.0 « L
Legal Description: egz_ T S 72G9 4� L�T//ly Dy
6 7— 36�)
Property Tax ID #: S7-cl O - O/5 3 -- Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
�5 Gsq-GL 7 ><�sr� we A o� .p V �2
nal work to be pertormea under tnis permit -
Mechanical _ Gas Tank —Gas Piping
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of.Construction:
Cost of Construction: $ �F _rp -"-
Block No.
all that apply:
_ Shutters _ Windows/Doors
Generator _ Roof z7h Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWf�ER,/LESSEE
CflNITI RMANO MaR`:
Name.
Name:
Address: Z S- Z > !9
Co"rri pa ny �O.y�� ��lG Sd"1L i � L C
Address: X-"cv
City:` ��w' �i% • 6 e_16 Z� L State: L
City:, State: >cL
-Zip C d 3 y9S- Z Fax:
Phone--Nol.
ZiplC,odeFax:
Phone N.o - .%7Z Z Z (4 �3 i
,E=Mail:
Fill -In fee simple Title Holder on next page( if different
E-Mail:- /'� 7w1L7 c'�- 5 ! ��y / r''``�•
State'o_rCounty. License CG G
from-theOwner-listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencdment_is�required.
S PPLEMEN AL CDNST t 1111 EN LAW WE
wQRMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:. _.-_._...
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: - Phone:
FEE SIMPLE'TITLE HOLDER: _ 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.
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,,[ 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 recording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Cont actor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF_\
The forgoing instrument was acknowledged before
me
The forgoing instrument was acknowledged before
me
this �'21ay of (3-4) e 20�by
this day of _LYO +e 20J by
(Name of person acknowledging)
(Name of person acknowledging)
Signature of Notary PubAVState of Florida)
(Signature of Notary Public- St of Florida )
Personally Known OR Produced Identification
_�
Personally Known OR Produced Identification
_
Type of Identification
Type of Identification
Produced i
:was' "0'
Produced
Commission No. (Seal)
i ll11 H
Commission No. (Seal)
D=
�,.
��
.�\•\0��
AI
�
S' O mi =
F
�IIIII\\\
N
TA o D.
O
3ve
REVIEWS
FRONT
ZONING
R
PLANS
VEGETATION
SEATURTLE
M
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
d�Vo z
DATE
RECEIVED
ow. o o°
aQ2
DATE
COMPLETED
M
ev.
y�Qo
o_tiy