HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLE.-__ FOR
///ApppPPLICATI O BE ACCEPTED Y1
Date: - �tj 3 Permit Number:
0
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 TYPE:
Address: -1�
Property Tax ID #:
Site Plan Name: _
Project Name:
RECEIVED
ED 9
Bu"ingermit Application MAR 0 6 2010 `'60
Permitting Department
St. Lucie County
Commercial Residential /
Additional work to be performed under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ ei-QX)n — Ocn
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic
)I zi � )
Lot No.
Block No.
Windows/Doors
Roof Pitch
Building Height:
00.61M IESN
CONTRACTOR:
Name
Name:
Address:$5\B
Company:
City: \13 �LoGyc�[-a4 State:F\�
Zip Code:y.J'L��o$ Fax:
Phone No. �`\'� `�c� \ ���
Address:
City: ` m NZ-AC-N-�
Zip Code: Fax:.
hone No
State: 1 -
E-Mail:\61a� CL'J��oD Q Z]LLN�b
Fill in fee simple Title Holder on next page (if diffe ent '
from the Owner listed above)
E-Mail \St, a[L'bONc
rJ
State or County License
��� N �-
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 ENTA CONSTRUCTION LIEN W INFORMATION:
DESIGNER/ENGINEER: of 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: _ of Applicable
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 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 orandlcovenants 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
Well11LLI-1�ItlIlT�§�[�]GiH�[�iK�] [lIIIT��L�llli\ [Ui[Ka�ii
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA L L���
COUNTY OF S Y
The forgoing instrument was acknowledged before me
this _J_A day of rfU • 204 by
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of 20_ by
ou-\40;-pia ,RSN\Q�k
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
hggnature or Notary r -
`,R o
ice` °' State of
Commission No. = Com
o.,?or
.�.. My
Coll
REVIEWS ' FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED'
Personally Known OR Produced Identification
Type of Identification
(Signature"of Notary Public -•State of Florida-)"' ' '
# GG 270079 II 1 Commission No.
(Seal)
SUPERVISOR I - PLANS VEGETATION' I SEATURTLE- MANGROVE
REVIEW I • REVIEW I REVIEW I REVIEW I REVIEW