HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONL
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: \ a- SCANNED Permit Numbe
ar:
_ BY
St. Lucie Oolihty 0 EG7��IJ� JJ
Building -Permit Application DEC 2 1 2011
.Planning and Development Services
Building and Code Regulation Division BY:.......................
2300.Virginia Avenue, Fort Pierce FL 34982
Phone: (772).462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from deopbox, click arrow at the rend of line 3
PROPOSED IMPROVEMENT LOCATION:
Address: Gi US ®.ts p u'ni r T Tc° .2
Legal Description:
Property Tax ID #:.3 ,VAS .5,0 k DI)AS olor) V Lot No.
Site Plan Name: Block No.
Project Name: / �� 7 D Rusk gjfC.4at
Setbacks Front Back: Right Side:. Left Side:
DETAILED DESCRIPTION OF WORK: III
(N#a1)
S1G�+ �,1%-{Ar ,
I CONSTRUCTION INFORMATION: III
�HVAC Q Gas Tank E]Gas Piping Q Shutters Windows/Doors
Electric Ej Plumbing
�[:]Sprinklers.Generator Roof � . Roof pitch
Total Sq. Ft of Construction: Qn 3 S Ft. of First Floor:
Cost of Construction: $ 02.'� 6� Utilities: Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name S%/uciP c i
Name: 'Ciego9i.✓ XleAlf
Address: PO Ro X 17
Company: '
City: 1.4Ia-4State:
Zip Code: Fax:
Phone No.
Address: 24S. 2(a _7W
ST
City: fJ124
Zip Code: 3.3 VO Fax:
Phone No.
State:_
E-Mail:
Fill in fee simple Title Holder on.nextpage.(jf different
from the'Owner listed above)
E-Mail: �r»a Y �R �Ps41
V S ! S`4.Gf• LO
State or County License: dFci
no o j
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Count, makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or anScovenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 6,6" /$Rrti COUNTY OF 4t. i$t_aw
The forgoing instrument was acknowledged before me
this 24' day of NaXA-49z 20117 by
90_i(Jl�. L.J('20L'V (.Cn
Name of person making statement
Personally Known J OR Produced Identification
Type of Identification
(Signature ofNota Publi5tateofFlorida —_. — .__
DANIELLE JEAN HANNON
Commission No. otary Pq&kal)State of Florida
3' • . •= Commission # FF 995383
j�, UI My Comm. Expires May 23. 2020
REVIEWS I FRONT COUN ER I ROEVI W I SUPERVIS
REVIEW
Rev.
The forgoing instrument was acknowledged before me
thisztr day of r wc. sx2 .201_2_ by
I&IOG...1i L2,049af
Name of person making statement
Personally Known so OR Produced Identification
Type of Identification
Produced
�
(Signatureg Notary ObNc-�StaterofElorida•)--•---_._._
i�ar nya, DANIELLE JEAN HANNON
Commission No. • •ram= Notary 1§6It State of Florida
. Commission # FF 995383
11 �?' My Comm. Expires May 23. 2020
REVIEVI V EVIEWON I S REV EWLE I MREVIEWVE