HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �}
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Date: biro l % Permit Number: —1 LAS)-
.' SCANNED-
--- — Building Permit Application By
Planning and Development Services St. Lucie County
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:
PROPOSED
IIVI R TMEMENT LOGATIQ,,N.
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Address: 2J%� 6"�0r� A / orT
.,
Property Tax ID #: s It o o--a�] coo Lot No.
Site Plan Name: Block No.
Project Name:
DET ILED DESCRIPTION QF WORK:
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-el 'X361 X/0 Stee/ buir'i�i u� L�iQrQ / OH CoycdLf� �4a�
6111 ree4el /.Is 2-�61 X,36 L/i�+e%s -f-kek 20M PST eeKe--e7`e i✓1�4
CONSTRUCTI0.N INFORMATION:
Additional work to be performed under this permit — check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_ Electric _ Plumbing Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: P2 7 Sq. Ft. of First Floor: wy
Cost of Construction: $ t y Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ^ H e a
Name:
Address: Z32ursCompany:
City: State:
Address:
City: State:_
Zip Code:,
`Fax: q
Phone No. �0 6r / ' / yl� ��
_
=ZiprEoiie;n a^;.i - - "'°j' 1; Fax:
E-Mail: Sfewarr-4 VA4,0,1
rPhone
Pik 1) S
Fill in fee simple Title Holder on next (if different'h `"E`Nlail
9 nzra
page
from the Owner listed above)
,
tate o'r County License 4
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
SUPPLE- v ENTAL CONSTRUCTION LIEN LAW INFORM
TI 0
DESIGNER/ENGINEER:
Name:�ro n a �Bioe✓t1
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address: f�0 LSDx
Z
Address: '
v o O
�/�(,
City:
Zip: 2�D/'7 Phone—
State: L
City: „
Zip: �9�—Pho e:
State:
7 -
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
4Not Applicable
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
Sign wner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
S �Cxe_�
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledge before me
The forgoing instrument was acknowledged before me
thi�) day ofV— 2011 by
this_ day of. 20_ by
Name o 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
gna ure of Notary Public -State
(Signature of Notary Public- State of Florida )
Commission No.
;i5Asion -
4 eA)MY�MrON�
No. (Seal)
' r.... 'or
27WO
REVIEWS
FRONT
ZONING
SUPERVISOR
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
`
RECEIVED
1
DATE
COMPLETED