HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: W.J. I SCANNED Permit Number:4111111111111111111
BY
St. Lucie Countv Lt
Building Permit Application JUN 0 12011
Planning and Development services PER:VIITTi. IG
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
PROPOSED IMPROVEMENT LOCATION: III
Address:
Legal
Property Tax ID #: _ VS tqx�o Lot No.
Site Plan Name: J(/A"'o-A" Block No.
Project Name: S'/tYVI ll
Setbacks Front Back:
Right Side: Left Side:
DETAILED DESnCgRIIPPTION OF WORK: y
L Ceram
CONSTRUCTION INFORMATION:
Additionalworkto e e orme un ert Ispermit—c ec a apply:
1jHVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof = Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 31 z
S Ft. of First Floor: _
Utilities:n Sewer []Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address
Company:
, `,, ",,
City:`�+61�s� �L(L(l State:R—,
Zip Code:: Fax:t��i
Phone No.L +�T /
Addres: d T
City: Q� State:%
Zip Code ri tlr Fax:
Phone No.
E-Mail: DaslS?uc{o �. evw+
E-Maik
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License:
It value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not 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: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
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 lender or an attorney before
103
as
STATE OF FLORIDA COUNTY OF 9k Lucie
The forgoing instrument was acknowledged before me
this 10 dayof2011by
Personally Known &�' OR Produced Identification
Type of Identi . _-- _ _ _
Commission
Revised 07/15/2014
MY COMMISSI(%aWF 170384
EXPIRES November 2, 2018
s
o ctor/License Holder
STAT FLORIDA
COUNTYOF S},��JGtC'
The forgoing instrument was acknowledged before me
this _& day of 20 1�i by
(Name of p rson kno edgiUg4, i
Notary Public- State of
Pe pally Known !/ OR Produced Identification _
e of Identifi se''
A STEPHEN S ELTON
Commission No. `. A `�' rS
OMMISSIS� FF170384
EXPIRES November 2, 2018
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