HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMn�. ED FO PPPPLICATION TO BE ACCEPTED Q r,�q^
Date:�Iwd CC N TIPermit Number: _ I OO n' o i O pL ,
r . ' u , - No rQQ,l.u,16wounty �
Building Permit Apa CO 80V RECEIVED
Planning and Development Services
Building and Code Regulation Division JUL 16 2010
2300 Virginia Avenue, Fort Pierce FL 34982 Permitting Department
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial_ Residential St. Lude County
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
PROPOSED IMPROVEMENT LOCATION: II
AdaMs":tm I S O. S rL l L+YlI Nob lace P S L Pt- w qm
Legal Description:
ropertyTTID#:��j`1�`iS�I O� ���5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:
Right Side:
Left Side:
DETAILED DESCRIPTION OF WORK: III
10 �D�b►� dry✓e ,5ct-,-e
huh vJ
CONSTRUCTION INFORMATION:
1AUUMunai wurK w ue e1 wr meu unuer uns pennu—meat au apply:
1:1 Gas Tank �asPiping 1 _Shutters Windows/Doors
0 Electric El Plumbing // Sprinklers 1:1 Generator O Roof Roof pitch
Total Sq. Ft of Construction: / i {2 S�Ft. of First Floor: Cost of Construction: $ fl Utilities: —Sewer[]Septic Building Height: (0 4)+
OWNER/LESSEE:
CONTRACTOR:
Name :3'evin(' e/ aC
Vt
Name: CC L16(1
Address: 1660 4r!ati
Ub Place
Company: PL+
City: Sl-
Zip Code: ?y 9.5,2 Fax: -17a
Phone No. -77 ), - 3 35 -5000
State: a
^ 33S' YA
Address: t J
City: pis C- 1, State:_
Zip Code: _�7 �l /yu Fax:
Phone No. :% _29 - cf g'�_- ,37 k-
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: �(7)3 h 0.LLol • CAwt
State or County License: , o P
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
__�2Not Applicable
MORTGAGE COMPANY:
Name:
ONot Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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. Lurie 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 1 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
commencing work or recording vour Notice of Commencement.
��
C
Sig of a ontractor as Agent for Owner
Sign tur of Cdntractrcense Holder
STATE OF FLORIDA
STATE OF FLORID
COUNTY OFF
COUNTY OF L �l ` e
The tprgoing instrunlent was acknowledged before me
this dayof203by
The forgoing instrument was acknowledged before me
this_4dayof20 �(oby
Name of person making statement
`'
Name of person making statement v
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signa e o otary Public=State of laorida)
(Sigheurei of Notary Public- Stat of Florida )
° e�• (Sea1SHgRNq INGRgM
Commission No. + Nc ary public -
N State of Florida M•
y Comm.
Commission No. o�'"�"�a;. (Sea()1HNq INGRAM
�� Nota Public -State of Florida
aQe, Expires Dec 20, 2018
•? M Com
; as y m. Expires Dec 20, 2018
%;'oe r,o•° Commission dt ee .
q�
+ / �e a e
v
th_roo
ih'r.iy'4rary a.<n
q
,�„ Bonded Ih-
,, -
REVIEWS
FRONT
ZONING
SUPERVISOR.
PLANS
VEGETATION
SFATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
EVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17 q It" ,/