HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLE
Date:
_'FOR APPLICATION TO BE ACCEPTED .
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 Number:
'ZECelft
Building Permit Application MAR 06 2010
Perrnit—tingo,p- -
artment
St.
Lucle County
Commercial Residential
PERMIT APPLICATION FOR: SCANNED
By
Address: /9-7D0 Buz Vl—
Legal Description: 146� A'11 X, 14a 7Z
Property Tax ID #: 30147 eo Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front--&20;/&ck: Right Side: '5;P,/(eftSide:
DETAILEUDESCRIPTz
IOW,OF,WQRK'
as
—Mechanical '_Gas Tank —Gas Piping _Shutters V--W� indows/Doors
VE'lectHc _Plumbing Sprinkler's _Generator V'Roof *?/P Pitch
Total Sq. Ft of Construction: _ eo 'Sq. Ft. of First Floor: (RQ
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE.',E
Name JAM
e!Q Etisiw--:A�;,�
Name:
Address:* lef�-701
Company..-. -If-.
City:I C- &er State:
Zip Code:- 34-1 ? Fa - x
Phone No.
Address:
City: /--z
Zip Code: 31/5OE2 Fax:
Phone No -77� — D-16 — X?IQ
State:_,,�-�-e
E-Mail:
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
E-Mail
cries,
State or County License ef5'G6 /,6Z
2 22 7
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Nam
Addl
City:
Zip:.
FEE SIMPLE TITLE HOLDER:
Ivor Hppllcaole MORTGAGE COMPANY: _ Not Applicable
�✓ Name:
r� 49C Address:
State: L City: State: _
— �y- t22 Zip: Phone:
Not Applicable I BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
)WNER/ CONTRACTOR AFFIDVIT: Annlination is hprphv made to nhtnin n nermit to do the wnrk and Inctallatinn ac Inrlir.torl
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.
Signature of caner/ essee/Contractor as Agent for Owner
Signatu o ontractor/License Holder
STATE OF COUNTYOFORIDA 3-f `. `^, /1
OF ORIDA
COUNTYOFSTATE
The for ginstrur�en� was accknowledged before me
l
r
The forgoing instru n
w sacknowledgedAefore me
this ay of 1`--1C1SliC 20Q by
this, Le day of
20 by
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efs-e�
(Namd of person acknowledgin
(Name of person acknow
ging )
(Sig a Notary Public- State of Florida)
(Signature of Notary-
Florida )
ZyKnown
Persona OR Produced Identification
Personally Known
OR Produced Identification
Type of Identific Lion y M!�1I/��%jCORDERO
0
Type of Identification '
Produced NOg14RYPUBUC
Produced
STATE OF FLORI[IA
"`��V.`b
o,n ELLEN VAUGHN
=State ofjr
Commission No. (C@MI W FF2337B0
Commission No.
Public
E Commissror{#GG
Expires 5/21/2019
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