HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED F PP (CATION TO BE ACCEPTED
!y �AN�VED 11 r —7
Date: ���� _lT_ BY Permit Number: Fq�, — L� F—
St. Lucie Countv
RECEIVED FEES 0 4 201
-----_ Building permit Application R�cisrven
Planning and Development Services MAR 0 6 2010
Building and Code Regulation Division permtttinp ®e
2300 Virginia Avenue, Fort Pierce FL 34982 St, Lucie partment
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residentlaf '�
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
-
PropertyTaxlD#:Lot No.
Site Plan Name:
Project Name: 9t-2- z
Setbacks Front Back: Right Side: Left Side:
;zFi 0696&_ iUT �+rn.�ack�
L_IHVAC LJ Gas Tank UGas Piping
Electric Plumbing []Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 2 5W
Block No.
Shutters Q Windows/Doors
Generator Roof Roof'pitch
s Ft. of First Floor: _
Utilities: Sewer 1:1 Septic
Building Height:
OWNER%LESSEE � � E __ `�
CONTRACTOR ' ' `
x
Name li9YY1 S
Name:MQ�SVIS
Address:
Company%A 5te C=1
/^
City: 6001 2 State: r z-
Zip Code: Fax:
Phone No,
Address:
City:
Zip Code: 3 Fax:
Phone No. G� 3677�J 770
Statea,
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
s
jSUPPIEIVIENTALCONSTRUCTION UEN;lA1N INFOFtMA710N
} " �- � �� r � � ,
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY.
Name:
_ Not Applicable
Address:
Address:
City: State:
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER: _ 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 County makes no representation that is granting a permit will authorize the permit holdder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenantss 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 Vour Notice of Commencement.
ignature of Owner/Lessee/Coritractor�asAeent forMV -r'-
Sig�re of Contractor/License Holder
STATE OF iteMA COL-OV f)
COUNTYOF rJ PCt,SO
STATE OF FLO"
COUNTYOF YyrG
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledge before me
this ay of 'ld,l{kytti ,20J9 by
thisg�dayof 7=E,6,?O�,N.20-M by
W l i oixr Sasz-
.) &"65 `7 _Dfgy5 S
Name of person making statement
erso_
Name of paking statement '
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification j
Type of Identification
Produced Can ( 9 DQ-oLA %13-)
Produced
(Signat/ire of Notary Publ'
-
at of Notaryublic-Sta & Florida )
Commission No:
SMITH
40MIXY BLIC
Co
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ission No. =°sPe4P
STATE OF COLORADO
0 MGS ON %Fr0��669
�' ' o EXPIRES: Apdi 12. 2M
NOTARY ID20024015222
�Ppril°P Bondw Thr. mot Noury Semus
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VEGETATION
SEA TURTLE
MANGROVE
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SUPERVISOR
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DATE
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DATE
COMPLETED
Rev. 8/2/17