HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��R Ito Permit Number: lil ) lel I lS�
Building Permit Application MAY 0 9 2010
Planning and Development Services PERC41lTTIMG
Building and Code Regulation Division St. Lucie Cou y, FL
2300 Virginia Avenue,Fort Pierce FL 34982
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: gso-6 Lkw wood i0curtc /or
Legal Description: I , &.e,1,Jcir( {pG��(�, - ✓mac f l
Property Tax ID#: t 770 L-601 —003`(-Bd�J Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCR"IPTION OF"WORK.
$K7 /3adts-C ,foo" i1v rve
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CONSTRUCTION INFORMATION.
Acid itional work to be nertormed under this permit-check all apply:
HVAC 0 Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S . of First Floor:
Cost of Construction:$ Zy .1,() Utilities:]Sewer E]Septic Building Height:
OWNER/LESSEE:'. CONTRACTOR:
Name Rat-Il "f-D Name: J Z50,/
Address: -70 ( 515- (-Fdif hull/ IqCIC Company: 05�7u,-5 r�-✓G
City: (?S L State: L Address:_ ICJ? SCSr—
Zip Code: 3 y�j 9 3 Fax: City: 544f�� State: Oc= -
Phone No. (772.) t�'L 1 -0515 Zip Code: 27�Klf-6 Fax:
E-Mail: Phone No. (77L) 6'� —662-6'0
Fill in fee simple Title Holder on next page(if different E-Mail: e 'L tjpd rCV-1--?
from the Owner listed above) State or County License: O
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION': .
r
DESIGNER/ENGINEER: _Not Applicable MORTGAGE_COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: Stater
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not 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
comme"ing work ix recording our Notice of Commencement.
xm s
_Sig re of caner/Lessee/Agent Signat o ontrac r/Lice se Holder
ST TE OFF LORIDA ST OF FLORIDA
C LINTY OF .Lam,It✓, CO NTY OF. LSIni F
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of IN1PiiV 20 Eby this q day of 1M IAV .20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-`S ate of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identificatio agrsqnally Known OR Produced Identification
Type of Identification ProducedN g ,_ f Identification Produced E- , Q1,,I
Commission S FF 11 637
Commission No.FFI I s '° mal),Ay commission Exp rebm ission No. I ^1°fffo (Seal EN S. NIELSEN
wvru
June 12. 201
- Commission#
FF 115637
My Commission Expires
rN O. !291 g
,f•%!1:111 O,`,
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS