HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I O' Q3 D
,9 c
Building Permit Application SCANNED
Planning and Development Services St. Lucie COUntY
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34§82
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial x Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:, 5450J4_ 4-a .P1Qf% _f?(-tJ0. j—^_ 01-LQ_W2
Legal Description: 12.34.39COMM ST COR OF W 1/2 OF NW OF SEC 7-34-40
Property Tax ID #: 1312.110.0101.010.0 Lot No.
Site Plan Name: Block No.
Project Name: GERIATRIC SOLUTIONS
Setbacks Front5' Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
INSTALL FREESTANDING SIGN ALONG FRONTAGE FACING TURNPIKE FEEDER RD.
CONSTRUCTION INFORMATION:
Aaclitional work to be performed under tis permit— cheCK all Mail apply:
[JHVAC Gas Tank Gas Piping Shutters ❑ Windows/Doors
_
Electric El Plumbing Sprinklers ElGenerator Roof Roof pitch
Total Sq. Ft of Construction: 40 S Ft. of First Floor:
Cost of Construction: $ 2.000.00 Utilities:Sewer OSeptic Building Height:
OWNERAESSEE : ;', " "'
CONTRACTOR
Name" VlA0 t(2' .1 L�iDfO_S
Name: r670-AL41L
Address;.aS 3.\'
Company:''ObMINGOSIGNS .41
city i�0��.` S WC.�S State:FL_``, _
,Address" �Q�t�i',!�`t a®i?t4i�✓lC.4�
City: Stated FL
Zip Code: "3`-/g S _5 Fax:
Phone N0.203-1887
Zip Code: 34997 Fax: 220.7768
E-Mail:
Phone No. 220-7377
Fill in fee simple Title Holder on next page ( if different
E-Mail: flamingosigns@aol.com
State or County License: ES 12001146
from the owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTALCONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name: OAS C-
MORTGAGE COMPANY: Not Applicable
Name:
Address:'Q4,nn% S`L O_o c.Q s:( f3r0 `c
Address:
City: 4-1oi3t State: FL
Zip:3M55 Phone263s67r
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: __gNot Applicable
Name:
BONDING COMPANY: 0 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 foF
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
Signature of*Ownec%LesSee/Contractor as Agent for Owner
STATE OF P42 g
COUNTY OF FLORIDA 4 /
The forgoing instrurair�ent was acknowledged before me
this �� day of Ulf e? c--u 201'1 by
Name of person Waking statement
Personally Known OR Produced Identification
Type of Identific,,��jjtion
Produced U/L- L_rc L- "sL
(Signature of Notary Public- State of Florida )
Signature
STATE OF FLORIDA
COUNTY OF bit /J A F
The forgoing Instrument was acknowledged before me
this /� ddayof dcyaP-a ,201 � by
kDOIFti7 /r'1Ie c%t/=
Name of person making statement
Personally Known Li OR Produced Identification
Type of Idegkfication
Produced 2 ekT4 2 r
(Signature of Notary Public -State of Florida )
Commission No. //'�- ' Nb li„bwcgtatedFwrld� ommissionNo. o '� R Mbw�toofFWd,
Robert M Rice
�• My CornrriWion GG 072776 +` MY Commisalon GG 072776
REVIEWS I FRONT ONING PLANS
COUNTER I REVIEW I SUPERVISOR
I RE VIE I " REI S REV EWLE I MANGRO REVIEW
1 COMPLETED
Rev. 8/2/17