HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONa
11
All APPL-IC/ LE INFO MUST BE COMPLETI
Date: //
FOR APPLICATION TO BE ACCEPTED
Permit Number: 9/) I
SCANNED
BY
E R r , at. 'Lucie count/ RECEIVED
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Building Permit Application JUL 11 2010
Planr�ing and Development Services
Built i``ng and Code Regulation Division Permitting Luc Countyent
St. 6utle County
2300 Virginia Avenue, Fort Pierce FL 34982
Ph/p ne: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
P/�RMIT APPLICATION FOR:
ress:/0%r��%%i��.
it Description:
Property Tax ID #:
Site Plan Name:
Project•Name:
Setbacks Frontz
Lot No.
Block No.
Additional work to be pertormed under tnts permit— check all tnat apply:
IV Mechanical _ Gas Tank _ Gas Piping _'Shutters _ Windows/Doors • ` '
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: -�� 1 —I�� % Sq. Ft. of First Floor:
Co�Construction: $ 7 50 Utilities: —Sewer —Septic Building Height:
Name1)o,)'9y D, C-/Z/ FF I -A Name: , 1►�NGt. �� l;kDQ
Address:
Companyjzt3 %�[L (A �%ZQ 1�%CL 10
City: rMe R. re State: , Address: n. P a x kt3 19,7 �r �d �'Q I k ibr-
1 Zip Code/ q 4 6 Fax: City—Qh &,
1 1Phone Nokr)% 9-- u K 5't L 5 5�' Zip Code:
"E-Mail: Phone No 6
,,, /+
Fill in fee simple Title Holder on next page (if different E-Mail • ' 1 V
from the Owner listed above) State -,or County License_
If value of construction is 2500 or more, a RECORDED Notice of Commencement; is required. .
4
SUPP EME ITS C70NSTRUC 10N .1 N 1.A1t4(1N
C1RIilIi�Tlt lU: � �
DESIGNER/ENGINEER: _ Not Applicable .
COMPANY: Not Applicable
;,,MORTGAGE
Name:
_
Name: _ . . . �V
Address:
-Address:.-
City: State:
'city:" State:\\',
Zip: Phone
Zip: Phone: 11
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable,
Name: Name:
Address: Address: 111
City: City: 111
Zip: Phone: Zip: Phone: 111
111
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
is in
which 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. c
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. 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 our. Notice of Commencement.
.
Z � CQ"e� J) W", Ax'w
Signature of OwneFKessrei/VMtractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ku C-4 .t
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this J day of v-DI W 20ffby
this day of M.. 20_ by
T I
r
(Name of pefson acknowledging)
(Name of person acknowledging).
(Signature of Notary Publi ate of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification--��
Type of Identification
Produced �,1d�i ,�,,,,,
Produced
Commission No. (Seal) 9 .
Commission No. (Seal)
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