HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLEIw rOR APPLICATION TO BE ACCEPTED Y '
Date: .Xck Permit Number: i1d�' GCOWIE b
RECEI�' =D JUN 2 9 2011 SCANNED
BY
1° St. Lucie County
---- ---- - Building Permit Application
Planning and Development Services
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: ,fin a -i\ v lne-A'r S,q V\
Address: L-O-V� W 0 0
Legal Description: t-c�
., 300 L
0 L, )
0 DA - L-, . , A- -% -) /-�, -
S!
Property Tax ID #: I i 0 1 (v 0 0 0) - 0 0 0- DL Lot No.
Site Plan Name: _l�;.l� (��� PbCwl, S, P—riorc A-✓c- Block No. I G L
Project Name:
Setbacks Front Back: Right Side: Left Side:
9
_Mechanical _ Gas Tank _ Gas Piping _Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ to, 000
Sq. Ft. of First Floor: _
Utilities: _Sewer _Septic
Windows/Doors
Roof . Pitch
4
Building Height-
N
CONTRA OR:
'arise
Address: `7S0S G/�2� �d
Companys-Cli--'13��i��
State:FL_
Zip Code: Z3,5 -gj Fax: y7.2-'/G�c-93,0
Phone.No.-77-7-Y4q- 9377
'Addre'ss:-'I�'njn `G.,ti�ho ✓{r �i
City: i%,4 ?*-rl-c State: FL-
Zip Code: 3g0i' Fax:
Phone No (7) it SI °! - $Q8
E-Mail:
Fill in fee simple Title Holder on next page (if different
m the Owner listed above)
E-Mail �f� Jcrf�ao�c�� L�� v I • cA
State or County License
If value d-Peonstruction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATfON:
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:
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 concurrericy 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
rnmmonrinp ininrk nr rprnrrlinp vnur Nntirp of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature Contractor/License Holder
STATE OF FLORIDA
COUNTY OF S?. Lv c.l F
STATE OF FLORIDA
COUNTY OF 5k.
The for oing instrument was acknowledged before me
�PQLIL- by
The forggoing instrument was acknowledged before me
this 6+4yr day((of k(or 1 20 1%by
thisydayof 20jJ
Lj) (z-y-4I#JE �US'�
VlG"'li�'-• k3ecJor)
(Name of person acknowledging)
�P
(Name of person acknowledging)
accknowlwledging )
(Sig atureI� c Stag Florida)
(Signature otary Public- State of Florida )
Personally Known OR Produced Identification
XZ
Personally Known OR Produced Identification
Type of Identification CHRISTOPHERJ.FR
Ll " R
,T��le of Identification ;
Produced
Produced I 1 6 G NOTARY PUBLIC
oo:•• •u LLEEN SUE HAYES
STATE OF FLORID
Commission No. FF 14'Z Il��-'7 �ommk =F142814
p '�@ Co1��+{y3� ppion q FF 2os728
Commission No. 1=�1 4 - My�o�fm�ss�on Expires
4CE 14� e Expites7/17120f8
%%'..1 March 15, 2019
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
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DATE
1i�1t
RECEIVED
4
DATE
COMPLETED
Rev. 7/2014