HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO /MUST BE COMPLL, �D FOR APPLICATION TO BE ACCEPTED ry', /�
Date: r� F �/ Permit Number: J ` ^ q —00 70
SCANNEDBY O -1 )
• St. Lucie County
� - --I Building Permit ApplicationC0t. �'
Planning and Codelopment
ion Dices ✓ �
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address:
Legal Description:
PropertyTaxlD#: P/30 131
Site Plan Name: ��� `
Project Name: �/�E.Ys.J
Setbacks Front Back:
Mechanical
_ Electric
Tota I:Sq--Ft_of_Co i
Cost of Construct
_ Gas Tank
0�.
• A
• Irk
Right Side: Left Side:
Lot No.
Block No.
_Gas Piping _Shutters —Windows/Doors
Sprinklers _ Generator _ Roof
I D
_ - — Sq.,Ft_of-First Floor:-- __
�.--- Utilities: --Sewed __Septic_, Building,kieight: _
OWNER/LESSEE: -
CONTRACTOR:
Name 2-fa `
Name: �/
/
Address: of Z% 5 a'/
_
Company: f ✓
City 61� t Zy State:AA
Zip Code: Fax:
Phone No._��,,4 - j
Addre P�
City, �State:
Zip Code 7iY G ax`—Arl 1cT1rE
Phone N 7 �/6
E-Mail
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License rJ 5
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SU PLEMENTAL CONSTRUCTION
LIEN LAW INFORMATION:
DESIGNER �VGINVR: J
Name: 0 d ?V
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Addressppp O
Address:
City -
Zip: Phone 72T
, State:
-1135�1
City:_ State:
Zip_ Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPA . _Not 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 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 len er or an attorney before
comet inchm work or-ecordine vour Notice of Commencemectt!7 i
"Ali
STATE OF FL
COUNTY OF
re
STATE OF FI.
COUNTY OF
The fQcgoing instru nt was acknowledg d re me The forgoing instrument was acknowledged before me
this �5 day of 20 by this _ day of .20_ by
Name of pe on acknowle g) (Name of person ack dGledging )
-(i a of Notary Public -State of Florida ) (Signature of Notary Public -State bf Florida )
Personally Known OR Produced Identification Personally Known roduced Identification
Type of Identification Type of Identification
Produced Produced , o acesa. DAWN MILONE
-. OWYFublic- -'•� �:"'_ Notary Db1wNMl(pyF"''�
• Sate of Florida P
Commission No. `s' .r MyPires Marpy, 201 -ommission No. =�,
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'''•°`� ;;o-O• o� mmission •,,o, ..o °:•`'. c ExPires Mar p Floric
Bonded rhrouae u,#EE 877571 -,.... �:. Fend•.rmmission'o cn'_2.201
REVIEWS FRONT ZONING SUPERVISOR I PLANS VEGETATION 18EATURTLE I MMMIRd
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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