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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION.TO BE ACCEPTED Date: C)- I(e) Permit Number: LQ b- e = R- �� _ �,��� Building Permit Application SEP 0 2 2010 Planning and Development Services Lucie PERMITTING 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 PERMIT APPLICATION FOR: PR®'P© DSNURN A NTOION: Address: Legal Description: Property Tax ID#: ��� y3/ - �y / aZd^ / Lot No. Site Plan Name: Block No. Project Name: / Setbacks Front Back: Right Side: 11 Left Side: D TAILED DE�S�C`al 'TION � F OR+, CONSTR OT11 NIIINVARRU2 TION: Additional work to be pe orme un er this permit-check all that appy.. _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric 'Olumbing _Sprinklers _Generator _Roof Total Sq. Ft of Construction: Sq. Ft.of First Floor: Cost of Construction:$ ���D j Dy Utilities: —Sewer —Septic Building Height: OW' �E /LE�SSaEE: CO TR CTO,R: Name Name:: t-W�� U Address: 1-:7-0 `� L.J�� �e ��/` Company: City: ��, 'O; �' i _State: Address: - Zip Code: -3 c/f 6Z� Fax: 72-2- 1;�7 City: State: Phone No. 972- ;r Z J 7 Zip Code: Fax: E-Mail: Phone No Fill in fee simple Title Holder on next page(if different E-Mail from the Owner listed above) State or County License If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SUPPLE ENTAL C•ONSTR CTI®N LIEN LAW INF®'RMAThON: 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 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 our Notice of Commencement. Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF ��'�' I�1�IF, COUNTY OF The forgoing instrunt w s acknowledged before me The forgoing instrument was acknowledged before me this day of 20 by this day of 20_ by Wr 1" �+� ' Sohc�Sor�� (Name of person acknoWredging) (Name of person acknowledging) (Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identification ntification Produced EL 0.�-- KAREN S. N Mr>38111cecl Commission# F 515637 Commission No. My Commissio pR rArissi No. (Seal) June 12.. 88 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev.