HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2.0 Un Permit Number:
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OCT 1 1 2010
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Building Permit Application
PER:xAITfi��G
Planning and Development Services St. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PRQPQS�D IN;P�RO\/EMwNT`` .LO-RAN, !ON;
Address: S v-c
Legal D scription: C �^ �-�' z A 2 S 2 r v� P 1
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Property Tax ID#: CX,'l (e—CDO 0-02:) Lot No. 1
Site Plan Name: Block No. ;2—G
Project Name: /
Setbacks Front Back: d�Z� Flight Side: `7c Q—Left Side: c cJ Lr
D`E��AILL�D DE�SCR�I�PTfQ'N OF U1/® �K:
CAJ k V\ w�S�- f %—C- 14Ad-n4--> 5^ C`�nzN• -� S.
WC14r- Y\® gd�k!�n i11u1
C4:N TR�UCTI N �14059R.�,\=,AA`Tlff
Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters L""wlindows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: '\-y Sq. Ft.of First Floor: y�C7
Cost of Construction: $ � Utilities: —Sewer —Septic Building Height:
OUVN ER LSE S E: CO' ACTOR:
-P 1 0
Name Name: -, S
Address: 013 C ' z Company: S r3 �� Cp•� v ��-���
City: State:_ Address: ��Z �m !� U (C3C_3'
Zip Code: ' C( �� Fax: City: (5G• State: F11
Phone No. Zip Code: 3 �'`OFax: `� G(- 7-7S--1117
E-Mail: Phone No G Z C-"(7_G`0 d
Fill in fee simple Title Holder on next page(if different E-Mail c`(�[J� lr�-��9-►�� O Co c•�D 4-'%i t5 C Dn
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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CERTIFICATION:
This application is hereby made to obtain a permit to do the work and installations as indicated,and to obtain a certificate of capacity,
if applicable,for the permitted work. I certify that no work or installation has commenced prior to the issuance of a permit and that all
work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that separate permits
may be required for ELECTRICAL, PLUMBING, SIGNS,WELLS,POOLS,FURNACES, BOILERS,HEATERS,TANKS,
AND AIR CONDITIONERS,FENCES,ETC.,not otherwise included with this building permit application.
St. Lucie County makes no representation that its granting of a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Homeowner Association rules, bylaws or any covenants that may restrict or prohibit such e
structure. Please consult with your Homeowner's Association and review your deed for any restrictions which may apply.
The following building permit applications are exempt from undergoing a full concurrency review: room additions, accessory
structures (all types), swimming pools, fences, walls, signs, screen rooms, utility substations & accessory uses to another non-
residential use.
NOTICE 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 YOUR k
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
P�Tt51� P.I'I7I�' T: IF IT IS NOT YOUR RIGHT,TITLE,AND INTEREST THAT IS SUBJECT TO
ATTACHMENT: AS A CONDITION OF ISSUANCE OF THIS PERMIT,YOU PRON41SE IN
OCT 1 1 2016 GOOD FAITH TO DELIVER A COPY OF THE CONSTRUCTION LIEN LAW NOTICE TO
THE PERSON WHOSE PROPERTY IS SUBJECT TO ATTACHMENT.
PER A1TTiN, G
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O OR CONT CTOR SIGNATURE CONTRACTOR SIGNATURE Thedore P.Sabatello
TATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Palm Beach COUNTY OF Palm Beach
The foregoing ins rument was acknowledged before The foregoinginstrumentwas acknowledged before
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me this�1 day ofJ20 /,, me this O�a" da of
y� 1�� Y by 4AN Q 6101 by I?ZL
who is personally known or has produced who is personally known or has produced
rl as identificatio . as identifies n.
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Signature of Notal Signature of Notary l
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Commission No. ,•T' "gin;=, DEBRA J KS Y
{{� Commission J.BROMal)
ommissian 083257 : ::
a Expires April 15,2018 Commission#FF 083257Expires April 15,2018
°:` Bonded Thru Troy Fain Ineurenco 800-385-7019
P"'�� 1. •h�„Rd Q0.• Bonded Thru Troy Fain Insurance 800.385-7019
NOTE: TWO(2)SIGNATURES ARE REQUIRED. EACH SIGNATURE MUST BE NOTARIZED. IF APPLYING FOR
THIS BUILDING PERMIT AS AN OWNER/BUILDER,THE OWNER MUST PERSONALLY APPEAR TO SIGN
THIS APPLICATION IN THE OFFICE LISTED ON THE FRONT OF THIS APPLICATION.
OWNER BUILDER AFFIDAVIT WILL BE REQUIRED FOR ALL OWNER/BUILDER APPLICANTS.
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For specific instructions see appropriate permit checklist.
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