HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: s I
MT
Building Permit Application MAR 17 2010
Planning and Development Services P E R t1I TTI NG
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential L'X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: '�n" 1QD Jnllri®
Legal Description: I% 3u LLQ SS OR b !;w 14 0C- tL u% I lu LzSc w JqD r-t-
AWJ E 201-lrt PAA d WS S LAD -f-T - 13 M Irdr i o ed
Property Tax ID#: IkAJ&-?-Q3- (`1 mO - Ooo-4:� Lot No.
Site Plan Name: Block No.
Project Name: iAC COCK C,
Setbacks Front Back: Right Side: Left Side:
[DETAILED DESCRIPTION OF WORK:
9. is tvV-s �Z= 'to cl Ck Ytrr 1 -to c" ns-+O-u r uw
VJ�l ;'(Y\staJa ,met'i S11 I V-"5(C 0 0 P
3000sob ff l I Z p�+stn
r %A(3 � LI -02 o(
12 •Oco -P694 c. O I% 1A l - 003.bZ
CONSTRUCTION INFORMATION:
Additional work toe nertormed under this permit—check all appy:
❑HVAC 0 Gas Tank ❑Gas Piping Shutters ❑brR
i ws/Doors
❑Electric: . ..:::;❑Plumbing,; ❑Sprinklers ❑Generator of
TotalSq. Ft 'of Construction:.t I S :Ft.of First Floor:
Cost.of.Construction'-$. "�1 `t0�1 UtiIties:�5ewer❑Septic Building Heigh t: S'FA
OWNER/LESSEE: CONTRACTOR:
Name ,)oVin Name: \nen be�CQ
Address: - Company: u.
City: a puica State:�. Address: 1
v
Zip Code: 3U CILI�0 Fax: City: State:
Phone No. Zip Code: Fax:
E-Mail: Phone No. - Q
Fill in fee simple Title Holder on next page(if different E-Mail: a E)i'I/I D 1Ct5.
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ of Applicable MORTGAGE COMPANY: _ of Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER:. _Not Applicable BONDING COMPANY: of Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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
commencinR work or recording our Notice of Commencement.
Jc� ze-te s
_Signature of Owner/LesseeAAfent Signature of Contractor ' ense Hol-&r
STATE OF FLORIDA STATE OF FLORID
COUNTY OF \� a-U\ &veli COUNTY OF SY�.lct,y�,Y�c .
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisL day of NkCX"6) 201_�e_by this I day of LJ12,rC \ 20 la by
kR_kfNN
(Name of person acknowledgin (Name of person acknowl gi4rf�,8..
SONIA DESTAFNEY
SONIADESTAF I "' " MY COMMISSION#FF1 25420
! '+` MYCOM 20 `' a°,'
.........:P '•.'Foci°„ EXPIRES May 21, 2018
ture f N to Public-St to f' a t a ure of PubI 4 da NotaryService.com
(Signt O 39 4giA ) FloridallotaryService.c ry
Personally Known V OR Produced Identification , Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
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DATE
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