HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
SCANNED
BY
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:-(772) 462-4553— Fax: (772) 462-1578 Commercial
Permitt.
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St. QC16 caunti,Nent
Residential �(
PERMITTYPE: (AJ I ryl M I nA PUD
,PROPOSE I D IMPROVEMENT LOCATION: t
Address:- -Iuwq Gaijabno-el Or P `NIR, LP SL,
Property Tax ID #:332_2_-"16D - Oo3-1- 6-0-0 - 5 Lot No.,32-
Plan Name:
Name:
Additional work to be performed under this permit- check all that apply:
—Mechanical — Gas Tank —Gas Piping _Shutters'
3? Electric XPlumbing _Sprinklers — Generator
Total Sq. Ft of Construction: _QkS-A
Cost of Construction: $ ').), (oW -
Sq. Ft. of First Floor:
Block No.
— Windows/Doors
Roof I . Pitch
Utilities: _Sewer _Septic Building Height:
bWNER/LESSEE_;
.CONTRACTOR:
Name je6lfCAfjld
Name,
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Address: IuVt (QV�rf*1hKaY1r11y
Company:
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City: State:
Zip Code' 3"gLe Fax:
Phone No. SDS _qjj
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AddrAs
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City: _a_ r" �k-(0n&Y1_5_State:En_
'Zip Code: L4 Fam'S'W 71')Lj 2.2 f-I
Phone No I Z9
E-Mail: re 10 hl)\_j 6)w fy)pj d-((:)W
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
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State or County Licensem I q!s 8,U U a_
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.
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
A: I 'LYYY1L1-�
_
Name:
Address:2.21 "1 d IAA
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Address:
City: 23ra Li
State:FL,
City: State:
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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 concurrencyreview: 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 JOB SITE,BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WffjPrO--UR LENDER OkAN.&TTORNEY BEFORE, RECORDING YOUR NOTICE OF COMMENCEMENT."
i�ignat6Mr of;Owner Lessee/Contractor as Agent for Owner
S11igyraa/Lure of Contr ct /License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S07 Li-vti 1L
COUNTY OF _ f T— L G14
The forgoing instrument was ac�nowledged before me
The forp�oing instrument was acknowledged before me
this Zday ofPw. f ds ,2011 by
this of 20 Ygby
J44,�..1v v,1k
Name of person making statement.
Name of person ma ing statement.
/
Personally Known OR Produced Identification 19
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
: e - - -
,
1
(Signature of Notary,Public- State of Floro, Kenneth Nunez
(Signature of Notary Public- State of Kenneth Nunez
Q NOTARY PUBLI
Commission No. I `'STATE OF FLO
cQNOTARY PUBLIC
1@®mmission No. �4TATE OF FLORIComm#
*C91vi
FF94B32
�Comm# FF948352
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE -
.
RECEIVED
DATE
COMPLETED
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