HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ^
Date SCANNED Permit Number:
RfCE�� fD
_- St. Lucie County
oMI MAR 0 6 2010
. Building permit Appiicati®rfeS ittinv oe
Planning and Development Services t Lucie County ent
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
Address:
Legal Description:
Property Tax ID #: 1,01-7Oy 007E —DOO— $ Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
❑HVAC ❑ Gas Tank
❑Electric OPlum-bin
g
Block No.
J
Piping
UShutters
❑Windows/Doors
nklers
Generator
Roof
Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ �i�J Utilities. Sewer ❑Septic Building Height:
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CONTRACTOR
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Name O'oAR (4Q ewfv) T S I
Name:
Address: 5-1673,� In r l p Ef
Company. G �
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A�r� C2P� ItVG
City: 1"0
Zip Code: Fax:
Phone No. GAG a 3 —(3$S
Address: .
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city, , 4eA'I r'a,
Zip Codea!_
Phone No. 51;;�/ 33
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State:2e�__
Fax:
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E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License
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If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
3,,SUPPLEMENTA5,r,12 INSTRUCTION3LI N LAW INFORMATION
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
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.
J
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.
eignatt of Owner/ Lessee/Contractor as Agent for Owner -
ure of Contractor/License Holder
STATE OF FLORIDA 1
STATE OF FLO9A
COUNTY OF �d,i G.v', 'R 1ye t'
COUNTY OF
Th,e���rrrorMing instrument was acknowledged before me
The forgoing instru ent was acknowledged before me
thidayof 20IA by
this,2!�day of GiS/C( d-,2N ,20by
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�Q�'P D-'rho
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Name of perso aking statement
Name of pers ma Ing statement
Personally Known 1/ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
eProduced
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(S' n `ture of Not
I' - a f Florida.)
(Signatur of Nota Public- S to of Florida )
CO I5510❑NO.
c`µe JULIE BAqRpR��j�'\'j�
:+• Notary Public -IHOl2f Florida
"sty PUe,, ANG ,YO G
Commission No.
951069
,SC, pi Commission k GG 243242
: MY COMA11�F
m k EXPIRES:Apnl 12. 202D
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MyComm. EZpires Sep 28, 2022
Bonded throughNational NotaryAssn.
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Rev.8/2/17