HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE CON�.,.:ZTED FOR APPLICATION TO BE ACCEPTEL�'
Date: SCANNED PermitNumber: (�(q_tqm-
BY .
St. LUCie COUntv
RECEIVED
Building Permit Application DEC 2 1 2010
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue, Fort Pierce FL 34982 St. Lucie Countv
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: _1747 NOR'rI4 e) "4-1 jD,41gle ii� -1 �y F
Nr d�' got
Legal Description: O.Ancked
Property Tax I D #: 53 -ar Lot No.
Site Plan Name: Block No.
Project Name: AW40(le A.100V
Setbacks Front Back: — Right Side: Left Side:
DIETAiLED DESCRIPTION OF WORK:
C 0,vcAle7e 4e_ffr)R1,1f1oA_, '8ttc�vyyy 02,
CONSTRUCTION INFORMATION:
A(Ioltionalworl(toDe-pertormed underthispermit checkall apply:
0HVAC Li Gas Tank Pi In 11 Windows/Doors
- []Gas ping Shutters EIRoof
ElElectric Plumbing '' OSprinklers E]Generator Roof pitch
Total Sq. Ft of Construction: .
Cost of Construction: $ 4549a) - oc)
S, Ft of First Floor:
Utilities: Sewer E]
Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 6CL04AI 114eALIZ 41d'irlig e_&06 &T
Name-.,,',"_A,*Ae4r _Zr4f"
Address: J-1171) AlazAl 4614�1 A40LO
Compa , nv: S12? e - eov,
City:,&eJ_- Anelzre State"
Zip Code: Fax:
Phone No.—'?I)o?- 111- �9S'7
Address: Ao. 4K 6901A6
city: State:2/K
Zip Code: ?%f2? Fax:
Phone No. � '?ol -oflr- 0'6_!Y
,,I Xgfoel
E-Mail: C&q,74p-)ee CU&2ceffl &4j�Xpr
Fill in fee simple Title Holder on next page ( if iiifferent
from the Owner listed above)
E-Mail: edwf
State or County License: C1 C-Ca&(0-ti,
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 TITLE HOLDER: 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 conIct 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
work or record!
2-r
Signature 6f Owner/ Lessee/Contractor as Atent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF COUNTYOF
The forgoi . ng jns�Lument was acknowledged before me
thisd 2C�
�O day of Deri,�h?,e by
E204 1� uss
Name of per 0 aking statement
Personally Known Produced Identification
(Signa of Nota
N01 RM
'U' %
Commission No.. Wy P104S .f Fluida
COMMiSsion # GG 243242
C mm. Expires Sep 28, 2022
Fnnond,ec through NatiOnal NOtary A,,�
% PF Mv
The forgoing instrument was acknowledged before me
this J_!L day of 20-tElby
44.61001— _57WA�
Name of person making statement
Personally Known' V-' OR Produced Identification
Type of Identification
Produced
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Rev.
We of Florida
Fit. 4L
(Seal)
SEATURTLE MANGROVE
REVIEW REVIEW