HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE.INFO MUST BE =.., .ETED FOR APPLICATION TO BE ACCEPTS:;
Date: Permit Number: 9"QkVED
n—;-' DEC 11..1010
=all- Permitting Department
Building Permit Application St. Lucie county
Planning and Development Services SCANNED
BY
Building and;Code Regulation Division St. Lucie Coun
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED �IMP,,ROVEMENT. LOCATION:,
Address:
Legal De:
Property Tax ID #:
Site Plan Name:
Project Nam I: _
Setbacks Front
)3 /+Vt r�r i--,,4nEec M_
65.zip,g0
309 114 OpD4 0eo oZ Lot No.
1J & +D Block No.
Back: Right Side:
�F WORK: `
Left Side:
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CONSTRUCTION INFORM'ATION:,
Aaclitional work to Tenertormed
OHW
under this permit- check all
Gas Tank ❑Gas Piping
apply:
Shutters
❑ Windows/Doors
_
0 Electric
0
Plumbing
Sprinklers
Generator
41
Roof
=
Roof pitch
Total Sq. Ft of Construction:
-osto •ons r coons �23cso, w
S Ft. of First Floor: _
Utilities:ll Sewer 0 Septic
Building Height:
OWNER/LESSEE: „ ; ; _ �_�, , ". `
'CONTRACTOR:
Name I
DLA-5 94 A W4 Ta
Name:
Address:`Si1�o O r
Company:
City: TOI T S ;ace Stater
Zip Coder?` Fax:
Phone No. 777- Z6 1- 7 (Z.
Address:
City: State:_
Zip Code: Fax:
Phone No.
E-Mail: oIA ; 10• 129 a/n rJ
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required..
SUPPLEMENTAL CONSTRUCTf N LIEN LAW •INFORMATION:
DESIGNER/ENGINEER: _Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ of 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 Count makes makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contlict 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 ofthe 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 concurrency review: room additions,
accessorystructures, swimming pools, fences, walls, signs, screen roo �® cessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice o GJ (m cement may result in your paying twice for
improvements to your property. A Notice of Comm must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain consult with lender or an attorney before
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commencing work or recording our Notice of r ement.
X
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FL02Fj1p A
STATE OF FLORIDA
COUNTY OF 6�if . O< �2
COUNTY OF
The forgoing instrument was acknowledge before me
3 N
The forgoing instrument was acknowle d before me
day 0_ by
this day of V ec 20 by
this_ of
1no\a5 -�ob'%4ra
Name of person making statement
Name of personm4ing statement
Personally Known OR Produced Identification
Personally. Known OR Produced Identification
Type of Identification
Type of Identificati
Produced i-
Produced
(Signature of Notary P lic-S
dpitIEONEN=:
(Signature of Notary Public -State of Florida I
• ,».,,,, DEAHNA N N �p a22023
Commission No. QNPfC0
:,3T� rte,2020
Commission No. (Seal)
ar EXPIRE N�p�uMarMu�n
's�»o„ d�r sonde aTlw
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE I
RECEIVED
DATE
COMPLETED
Rev.8/2/17