HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAllAPPLICABLEAPPLICABLE INFO MUST BE COMPLI i FOR APPLICATION TO BE ACCEPTED \
Date: �� —� "t Permit Number: 1 L
• _ /�/� MAR 6 i 2010
- �- ---Building Permit ApplicatiordermlttingDepartmant
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Legal Description:
St. Lucie County SCANNED
BY
Commercial Residential St. Lucie Cour
Property Tax] D#: *Ad ll -111- bb)(1' boo 3
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
_Mechanical —Gag Tank —Gas Piping _ Shutters
_ Electric —Plumbing
_Sprinklers
_ Generator
Tota76'�Iq. Wof s H�Erructio�r :
Y>.A 0 ,
. . Sq.
Ft. of First Floor:
ructlort: CoAk,o o�r-st
�i
7v0�
Utilities:
_Sewer _Septic
Lot
Block No.
_ Windows/Doors
Roof S Pp: tch'�
Building Height: fb
IWN R/LESSEE:
CONTRA ORt
Name
Name: Scp,o
ff�..,,
Addr ss:.-S�l LJ W l�''�
' !tom
d
Compahy:
City: 1 State: _
Zip Code: Fax: _
Phone No.
Address: - D�
City: D State: , r
Zip Code: (o a. Fax: a4i 481 i
Phone N 11A 77a 37d
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail \1Cro Wy P,rPv `r)fep rhNli J dyf)
State or County License LICC /33D40
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SURPHEWE NSITRI, IEN LAW WFOR
ATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City: " 11
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 perrtit.
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'granthig 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 roorris 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. A
Signature of owner/-Lessee/Contractor as Agent for Owner
Sign ure of C tra or tcense Holder
STATE OF FLORIDA
STATE OF FLO D/1 /�
COUNTY OF
COUNTY OF 4 litre IC i Oe/L
The forgoing ips-t4i'ment was acknowledggg{ before me
The forgoing indent was acknowledgg� before me
this _day of b rCt71 20(I by
this day of 20/1 by
n� Vr, ba d .
b'de %sic, -r-
(Na of person acknowledging )
(Name of per on acknowledging)
(Signattirle of Notary Public- State of Florida)
(Signa re of Notary Public- State of Florida )
Personally Known,
Personally Known OR ProducedIdentification.
°
Type of Identificati t�+".'�:"'^�M-MM
Type of Identificati ,.__,��_.,,
"" MARGUERriEMESTOCK
Produced V:?"
produced
COMMISSIOM 238495:Oelober '=
'a il` BmNeEiMurloU7PohticUiden'mteis
EXPIRES: October 5, 2019
�+ Bon°e°t^" uO�yP u nmu
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