HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETE ,011 APPLICATION TO BE ACCEPTED
Date: ro N4 SCANNED Permit Number:
St. Luce County
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— - Building Permit Applicati
Planning and Development Services
Building and Code Regulation Division ST I ucie County, per y
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
J.
P.ROP.OSED INP.RO.UEMENT LQ@A„�TjION:
Address: 9 (. r," Lt 1b Q, A- P t 5'a> 6
Legal Description: T Cl Q iZk n1 c 3 c S O c c, bl 1 13 Sarl -rsc-A M d1 U tit t-r '"o 6
PropertyTaxlD#: -6ko-0o46-0ac->-o Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No.
C-14 A r(G4
< t L- iz G 14-e w 17.
V (> A M
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JA 4 JCL, i A
lVvk S i lk, $ A 114
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_Mechanical _ Gas Tank
,Y'Eiectric Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $yb CJb
permit - cnecK an tnat a
_Gas Piping _Shutters _Windows/Doors
_ Sprinklers —Generator . _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
OR Or, r, i q E
INGONTRACTOR:
NameV-gt4Lfr,rW4.3-a6i V01Vt1i(
Name:>�SviP1a ZJa��1GQ�'
Company:7. C,Q&vp L L C
Address:WLSO OR JkK5,L)o
City: 'irvti( .S Pn t V, State:
Zip Code: Q 1 Fax:
Phone No. 1 1- 4 Lf 9 1 v
Address: 7.,KB /;= S C 6
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City:
Zip Code: 3 cf,1ft,
Phone No -1 u 3
State: �� L
Fax: -1 (s'L
bG VI
E-Mail:
Fill in fee simple Title Holder on next page ( if different:.'
from the Owner listed above)
E-Mail GO
a CC �i-Svv�ld , g g�T
State or County License L
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If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL EONS Il - ,LIEN LAW INFORMATIO
DESIGNER/ENGINEER: —,Not Applicable
Name: o
MORTGAGE COMPANY: _ Not Applicable
Name: Nh
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: COIL
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 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 your Notice of Commencement.
Signature of Owner/ Lessee C ntractor as Agent for Owner
Signatur f Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTYOF 53r.1.0-cAC
COUNTY OF .✓iniinJ
The forgoing instrument was acknowledge before me
The forgoing instrume���n���t was acknowledged before me
thisVL day of � 201 by
this J_ //////��
day of 201& by
J -ate ON q-'s, ^
�E✓l f7l //� 7.4-e0_4 t ,
Name of person acknow dging)
(Name of person acknowledging)
(Signature of Notary -Public- State of Florida)
(Sig ture of Notary Pu State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced IfA-a ... MANNAMARIEGMM
Produced
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mbar 15•ppp
GEATAUDE ZACCAI
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Commission No. _ Fded p„clioundeiwdcers
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Commission No. 1 79147da
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Comm.mxpir Expires r13,20
Banded through NIUMI NataryAW.
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