HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APP ICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1Q. A
Date: 't Number: O 8� ltiE®
BY J
St Lucie County RECEIVED
Building Permit Application SEP 07 2010
Planni g and Development Services Permitting Department . Bull St. Lucie County
�g and Code Regulation Division � \� �'
2300 V"rginia Avenue, Fort Pierce FL 34982
Phon (772) 462-1553 Fax: (772) 462-1578 Commercial Reside"tlal
IT APPLICATION FOR: &IFPE`R�, _ 0'
Addres is_ g�n 101 IT ,P1 0Z(/f_BLV D. n— eS � L 34gt4 0
��� �ti'Q� L�� �T� eLk �7 Lar i is
Legal D scription:
Properi
Site Pla
Project
Tota I
Cost c
Tax ID #: l3ol Iod% OTO U 0 b6 Z
Name:
ame:
Front Back: Right Side: Left Side:
�iVMIR
�Agff .�IJ
Lot No.�
Block No.
nal work to be pertormed under this permit — check all that apply:
echanical _ Gas Tank Gas Piping _ Shutters _ Windows/Doors
ectric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
. Ft of Construction:
-onstruction: $��
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic
Building Height:
OWN R, 10R/LE-S9EE:
CONTRACI'O
Nam
Address:
City:
Zip Code:
Phon
E-Ma
Fill in
from
56tai2w PxcS
Name:
(Plol 'FT PlefeCt BLVD
Company:
Ff pig l2be State: F-
Fax:
No. Q
Address:
City: State:
Zip Code: Fax:
Phone No
II: ffnd0 kl &4
fee simple Title Holder on next page ( if different
the Owner listed above)
E-Mail
State or County License
If valuel;of construction is 2500 or more, a RECORDED Notice of Commencement is required.
WIN PLEME T L CNSTRUCTIQ LI �N LAW INFORMAT
DESIGNER/ENGINEER: _ Not Applicable
��
MORTGAGE COMPANY: Not Applicable
Name:
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, 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.
Sign ture of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The ing instr ent was acknowledged before me
The forgoing instrument was acknowledged before me
this of 201-3 by
�Tclay
this day of 20_ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
( ign ur6 of Notary Public- State f Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal;}HAHNA INGRAM
ommission No. (Seal)
�•SPar n�s.,�
;•_����•; Notary Public -State of Florida
.
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DATE
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COMPLETED
Rev. 8/2/17