HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
, J
Date: Permit N ®�umber:'i' � `�
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Resiidential
PERMIT APPLICATION FOR:
tiz rP�Cs}aEau sDs Nd"iPRaflUs,'=EMx+E.a.:�Iu . a�3CA7s !Ue' i 's s„-. ��E :s nk ir�i r -r �VTIM* 1X00'4 i4AW1,
N
Address: , 2.V
Legal Description:
Property Tax ID#:aSK Lot No.
Site Plan Name: Block No. 3
Project Name: 30 2V S•i1fll--zrle_A5r- 4a.4I'
Setbacks Front Back: Right Side: Left Side:
y �s�,.,.1, .b axrrz ���sk?Gf >ae.,;t ,E41� i��4, y„ b+
4�G x as
€ u :
DETAILED D�EESCRIPTICN�CFWORK �;� ��
�sn ..zskr
SM.411 ca,F rf U ja �'xv, ?D j2v-3' r x„X/ Dalv�wr�/1
E
CONSTRUCTIONINFORMAT(ON ryr x h r , {�
Additional work to be pertormed un ert is permit—check all that appy:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: ' Sq. Ft. of First Floor:
i
Cost of Construction: $ Ll Mom . Utilities: Sewer Septic Building Height:
Oi1FNR/LES�S`EE :T C{3NTRA' TOR:
Name M � i1f !nC, ,/-.-5/<"" "" II Name:1'.�/,�kfc�
Address:.f _3 o o It"'S:NT/x//Q V' ��sv�. Company:d .+A x'111 w rte L
City:,Kx State: r1d Address: ' 1 l�C' lQ S'ai S.'r,
Zip Code: .,4Y9_ a,�t_ Fax:. City: Stater
Phone No. im .gV7 �. � Zip Code:,• C/ip9 Fax:
E-Mail: t „Phone No 7722t7
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License �L
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required. J
� 111
SaU?PL1111�E1Y. Ct3N5, RUCTI;OL =_ OWA,FtDRl1J1Is
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.
St. Lucie County makes no representation that is granting a permit will authorize.thepermit 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 our Notice of Commencement.
Qhat_ure:pRl -Lessee/Contractor as Agent for Owner Signature of tractor/License Holder
STATE OF FLORID STATE OY FLORIDA.
COUNTY OF COUNTOFe
Thefgrgoing instrument was acknowledged before me The f�ongoing instrument was acknowledged before me
this day of rn0Lte3-\ 2011 by thisoU day of NQ_ _ 20 Ib by
(Name of persotY acknowledging) (Name of per on acknowledging)
(Signature of Notary Public-Sta of Florida ) ig�na of Notary Public- ate of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. lLgSHgHNq INCRA
*� Notary public-State M
0
�V Co xpires D,c 20,201
F40
REVIEWS FRO S PLANS VEG I"N'' f6 ''I#F 1p AtJG VE
COU
�otadB�F4VIEW LAS AHt1rVtAM EVIEW REVIE ationalNotaf�gh
DATE - a e o or di
'! : My Comm.Expires Dec 20,201
RECEIVED
DATEall Bonded thro gh National Notary Assr.
COMPLETED
ev. -
f�
i
. e
p 16T 5) z
40
I
Al e
Mr.Edward M.Pociask o�
3024 Satinleaf Ln.
Port St Lucie,FL 34952
I: J
-7
i;
vot'
� s
—73
i
f ?
N e w
r
Fi ii of� i