HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED pD U
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Date: Permit Number: 10 % • tY ?
SCANNED
RECEtvED
BY
p St. Lucie County JUL 31 7010
Planning �• Building Permit Application
Permitting Department
and Development Services St. Lucie County
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: To Select from dropbox, click arrow at the end of line
.P�kFb-4 IP,ROVFMENTLOCATION. "'
Address: {O;
Legal Description:
1
Property TaxlD#: LIP511--515'.» 00Is" -'�000 —I Lot No.
Site Plan Name: SCE U�d�l' oe LDYW O Block No.
Project Name: �\ rD CDYne.
Setbacks Front Back: Right Side: Left Side:
T-C.plaLce- s 1A a\"-�-
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CONSTRUCTION_ INFORMATIQN:;
rtiona wor to e e orme un ert ispermit-c ec a apply:
OHVAC �GasTank []Gas Piping _Shutters ❑Windows/Doors
11 Electric 0 Plumbing []Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ 1 rj k r)QQ Utilities:] Sewer Septic Building Height:
OUILNE' LESSEE ' a
CONTRACTOR
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Name if
Name: Natm�l 1ptaw
Address: I C� 1 1 h
Company: T0.Yl e+ f \Yt [,1
City: no'n4+V1 151MA&M State:hJY
Zip Code: IFJSg 0 Fax:
Phone No. 114— Z 1 S— qq iaq
Address:---5QI NE 1)OLLe-i- 96
City: f5t-mb C ' State:(..
Zip Code: 2tf!J4? 4 Fax:'—. -M4—i�
Phone No. 'tom Q • B34+ - IOt 1
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
State unty License: girt 131 ISl - 3
11
If value of construction is $2500 or more, a RECORDEu Notice Or Commencement is requirea. 11
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DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City: State:
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
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. Lucie Count makes makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contlict 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
commencingwork or recording our Notice of Commencement.
Signat Fe of O net/ Lessee/Cdntractor as Agent for Owner
Signat re of C ntractor/License Holder
STATE ORIDA
STATE OF FLORIDA �n 1
COUNTY OF �, . �11 Q.l�,
COUNTY OF 1 1 \0�7r'R-Y1
The r oing instru ent was acknowledge�}�efore me
The forgoing instrum�pt was acknowledged before me
this � day of _-I U `�� 2015 by
this day of , 20�8 by
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known _� OR Produced Identification
Type of Identific 'on
Type of Identification
Produced L
Produced
j� Q
Ill t ""_"
(Signatur of No=i7iwjune
e_ of Nota P lic- State of Florida )
REN S. NIE
No.of Florida•No[
mission is GG
SEN/cQ'i�Commission
rCd}fl¢}I
207484
on No�675g •o No�ypuOhc Stele or Flodtla
+ Donna Jayne Hall
commission
_xpires.
My commission GG 207585
a 12, 20
2
�i p� Expires 0411512022
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Rev.8/2/17