HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE CGdnr1ETED FOR APPLICATION TO BE ACCEPTL�
Date: I(� 1t`9 Permit NumQ
ber: l 1 I I ' C1 2j(-O-q
SCANNED
BY
s al St. Lucie County RECEIVED
Building Permit Application[uNOV 14
Planning and Development Services Z 0 19
Building and Code Regulation Division cie County, Permitti
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMITTYPE: i`Cn CC
PROPOSED IMPROVEMENT LOCATION:
Address: UCean Cs9c in-, n/`-
PropertyTax ID #: iHU - TL-t70c11-UCJCI - H Lot No,;L5_
Site Plan Name: Block No. 6�)--
Project Name:
I DETAILED DESCRIPTION OF WORK:
1 rIS lzi �� cj� r U �r- 4 A •1-17e nPni^e 1"r
CONSTRUCTION INFORMATION: I
Additional work to be performed under this permit- check all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Q Li ec,r- ere-t-
Cost of Construction: $ D,750
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
OW N E RAESSEE:
CONTRACTOR:
Name & %p• oJ— a r
Name: ,,S he ir)n
, 61-(S te-C
Address: allss 61uewcfter Or
Company: rcnc,nn LLC
City: wnr_SFa/ State:.&_
Zip Code: H 6 1�9y Fax:
Phone No. 77Z_-61&-ZC;(;
Address: 36f-J 2iLe- tiir�-E�c or -
City: F+- Vi'crrr State: f't;
Zip Code: 3419t16 Fax:
Phone No 77Z-37-1- 7�2G
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License 2_fs4-4
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.
� 19 //, 0
SUPPLEMENTALCONSTR
ON LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 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
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
`Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Holder
STATE OF FLORIDA
�i
STATE OF FLORIDA
COUNTY OF �hc�l Q dr. --I
COUNTY OF JZI,y
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this / day of /[/v✓ 2011 by
this' // dayof ,/UoJ 20jJ by
J)
II
Name of person making sta ment.
Name of person making statement.
Personally Known >0R Produced Identification
Personally Known' r//OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature ��yy t a
�REIIB.MILL�Seai
(Signatureo ,. ,u ic-Statego &on
Commissio 1
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Commission C►i V NYCDIAtOSSIONOW
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REVIEW
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REVIEW
REVIEW
FDATEVED
LETED
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