HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO>MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10-1Permit Number:
Building Permit Application OCT 10 2096
Planning and Development Services PERIAITfING
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: �� � � . �(���• �`���
..,008-RID 1 N i_'UV IVI T LOC`jATI`OWN
Address: 505 r' &a-- L ,_l T),r, Fod- r[>tes'ce , EL 'AW
Legal Description: AIC Onl tt
0
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
,DET'AI�L-E� DE�SC IPl'ION QF �OR�K:
1A OL I_ bt Q I^A LiAli �� r G�X1111911 I— ' Cor- A
CQN CriNIF RMATIO'N:
Additional work to be performed under this permit-check all tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
✓lectric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ �{-°�8� = Utilities: —Sewer _Septic Building Height:
®W ESR/LESSEE: ;,CONA;4,MV,
Name), a' /►an oc�r'�QZ Name:
Addressss: 'C 15 ��-a�c� 1-a.ke Dr-. Company:
City: t�n'&!keme State: FL Address: y
Zip Code: 3A95) Fax: City: State:
Phone No.07Z-) (243 -SK-2-2— Zip Code: Fax:
E-Mail: Phone No
TT
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.
SUPPLEMENTAL «O STRaUCTION LIIEN LAW INFQRI�/IATION:
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 recordin Vour Notice of Commencement.
Signa Own Lessee ontractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDAJSTATE OF FLORIDA
COUNTY OFA . COUNTY OF
The fo oing instr (yen was acknowledged before me The forgoing instrument was acknowledged before me
this day of 1 20�p by this day of 20_ by
(Nafle of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State o Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Iden ' ' aE
own OR Produced Identification
Type of Identification KA�S_N_S �' 20ro(a
fication
Produced )_ _ Commission q F
L
MY Commisson 12. 2Commission No. )5 X11 duneo. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE ---
RECEIVED
DATE
COMPLETED
ev. 7/2014