HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 11�
Date: Permit Number: aJ'
Building Permit Application FEB 2 2 2fft
Planning and Development Services PEW01-FTEIG
Building and Code Regulation Division St. Lucie COLInt ,.FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential v/
PERMIT APPLICATION FOR:
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Address: S51 ) t+tcv�or✓Y
Legal Description: 1,v w'J -?-kJc�tE 5 i F Z%� 6-1 T- Z I k
Property Tax ID#: `f0 0 L31 - C c)o d Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pertormed under this permit check all that appy:
_Mechanical _Gas Tank _Gas Piping Shutters ✓Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ _ 9 O�(.3 _ Utilities: _Sewer _Septic. Building Height:
Name, I m
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Address::"" SSIC� I-�tGkC�iz�' hut: Companye�i:3 �o,.l5i Z�c�is
City: vo Zi ►G ZCz State: f:�/ Address: �_•G • �h i �' ��
Zip Code: Fax: City: I��z-► �`� State: .
Phone No. 97 Z` S-(9 - (,?C) Zip Code: 3y9 `7"�'t Fax:279Z-`&w-03 ZS—
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-MailNET
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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SUPPLEMENTAL CONS TR<UCTI®N LIEN LAW I'NF®.R+I1/IATL®5N:
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
consult with lender or an attorney before
before the firs ' sec ' If you intend to obtain financing, cons Y
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commen_ci wo k'or reco di our Notice of Commencement.
Signature of Ow er/L ssee/ onttactor as Agent for Owner Signatilre of Con r for/License Holder
STATE OF FLORIDA {{� STATE OF FLORID
�
COUNTY OF �T• 1_00I� COUNTY OF ti '
The forgoing instrwnent was acknowledged before me The fo oing instrument was acknowledged before me
this day of 201_� by this day of 20V by
(Name of person acknowle ing) (Name of person acknowledgi )
(Signature of Notary Public-State of Florida) �(Signat�ureof Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Iden ' ican Type of Identification
Produced Produced
KAREN S. NIELSEN � aro��'' KAREN S. NIELSEN
, P p���
=� Com5i,6gi n N FF 115637 Commission No. S �,mission li FF 1156
Commission No. .e Y _ ._
My Commission Expires ',"�e mor,: My commission Expire
June 12, 2018 °;;,;o�' June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014