HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ^ ^ fO
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Date / Pj/\� p 4 & Permit Number: U1 1` 11
_,u RECEIVE[
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Building Permit Applicati n
and Development Services sT. Lucie County, Permitting
_ _Planning
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT TYPE:BY
a�AL
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Address:, /)7 /A10 1i0 !" r ieRCr✓ f is'
Property Tax ID#: 2, Oo0007— 000-0 Lot No. (1p_
Site Plan Name: vSM Block No.
Project Name: 'o I/fc
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Additional work to be performed under this permit — check all that apply:
echanical _Gas Tank _Gas Piping _Shutters Windows/Doors
Electric Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: % k 2 rd Sq. Ft. of First Floor: Z ,; y 0® 1
Cost of Construction:$ .0 0190 Utilities: _Sewer iSeptic Building Height: 1,9
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Name 1,) r l/r n&,ke
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Name: cDAVIT)
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Address: / Z._ 2 i
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Company:. A 1//, Ga1f/PA/ 11 fMA5 -w �—
City:��G 7 _�il!�ll State:/_
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Zip Code: Fax:
Address: /OD
/
City: milt- r lle'f State:
Phone No. L ,SSS 9?'63
Zip Code: 3Yi5 / Fax:
Phone No 7- ` 64 QAZ,
E-Mail: L1b,45r19LL1 ✓1!yR 77 ��1"mA/o /'U
Fill in fee simple Title Holder on next page (if different
E-Mail [OfllJ74 ✓660 f QN r46W-J- Co /
State or County License r/%/Z, 3/ q 0_
from the Owner listed above)
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.
St1PPiEN[EfT GL�ITEtCT(t<LtA! IAW INFQRM�kT(ON`'
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DESIGN ER/�E/NGINEER: _ Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name: --JPPP A4, .5h177-7k
Name:
_
Address: i7Nn �7 �,nd aK ,• vVt7. SrF3w
Address:
City: I�j)(�&,Jah State:_
City:
State:
Zip: l�21rt n Phone '77? , ,qJ,;*J
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not 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 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 COMM
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF C
POSTED ON THE JOB?SITE BEFORE THE FIRST INSPECTION. IF YOU
WITH YOUR LENDEf2 OR AN ATTORAIEY BEFORE RECORDING YOUR N(
Signature
as Agent for Owner I Signature
11T MAY RESULT IN YOUR PAYING
EMENT MUST BE RECORDED AND
TO OBTAIN FINANCING, CONSULT
�/YYC�1/'CYC�IT 1l
STATE OF STATE OF
COUNTYOFORIDA'511-/_ COUNTY OFORIDA
The forgoing instrum t was cknowledged before me
this day of 20L°_ by
Personally Known OR Produced Identification
Type of Identification
(Signature of Nota eKO gr a' NI[LSEN
io"pY PO, State of Florida -Notary Publi
Commission No. = +_ Commisgk911 GG 207484
=,a�o11; o`�c My commissionExpires
June 12,
The forgoing instrument wa acknowledged before me
this LZ day of 20/ by
U'I _7:ild .P
Name of person making statement.
Personally Known "/ OR Produced Identification
Type of Identification
(Signature of Notary
Commission No.
KAREN S. NIELSEN
ystate oi(6eai)a-Notary Pub
Commission rf GG 20746,
P 1,1 Commission Expires
June
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