HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE wMPLETED FOR APPLICATION TO BE ACCLrfcD
Date: I 10'-a�Permit Number: 1.
. i RECEIVED
Building Permit Applicatiorfcr2,192010
Planning and Development Services Permitting
n g aSt. Lucie �aunk ent
euildingland Code Regulation Division. y
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: _ BY
Address:; 0/0
S��yL� OAK
u, rya' Ay'geE
3W&a
Legal Description:
_LJArA,U Rza EA
EST/9TES - WymT OFa
- h�K /q 6-ems /9 A.Jn ao
Property Tax ID #: 3C/oQ " (O"7 - O i so -Eon - Lot No.
Site Plan Name: �lfs RFs-7-13 6,�J CE Block No.
I
Project Name: 539ACnC 54"'10
Setbacks
i
Front Back: /o Right Side
work to be performed under tnrs permit -
Mechanical _ Gas Tank _ Gas Piping
Electric _ Plumbing _ Sp'
' rs
3w 6Z Ica GEAR %`+s
Total Sq. Ft of Construction: 3yo0 xs4� S Ft
Left Side: /o
Shutters
_ Generator
of First Floor:
,-Windows/Doors
_21110of Pitch
Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height: �6 I
Name 44; i l;, 6 has Name: CA/1 Aa R-f- ef.JUA[
Address: 16/64 . Yt_uKw Dirk h_9 Company:
City: 46A'1 P_TEg (-'e State: r Address: 3-7 Sd N /77Arj
Zip Code 3L1Q8a Fax: City: fi1ouNT ArA i State:it)C
Phone No,. (%701 26- Y6,39 Zip Code: 0-7o 3 o Fax: C/ko - alb Z//d S
E-Mail:_/�fw Ae 4f l+: b&'5 /@ YAHoy . (.QM Phone No CIAO y/9 113 (, u
Fill in feejsimple Title Holder on next page ( if different E-Mail _7rco. e_ CAR pQg=e_k J7-A& . Coe7l
from the Owner listed above) State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Not Applicable
City: I State:
Zip: I Phone
FEE SIMPLE TITLEHOLDER:. _ Not Applicable
Name:
Address:
City:
Zip: I Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable.
Name:
Address:
City:
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 your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent fo 'tAa
CD U5
COUNSTATETY OFOF ORID1 ,� 'q^ipq•*p-
$ m�
The oing'instr e t was acknowledggQefore mo 0
this day of 'f' • . 20_ by o
U�
C - Q
Z�
C �T S
(Name of person acknowledging) �N
(Signature of Vary Public- State of Florida)
Personally Known OR Produced Identification
Type of Identifi • n
Produced
I.
Commission No. (Seal)
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of . 20_ by
(Name of person acknowledging )
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced
Commission No.
(Seal)
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