HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
`: E
Building Permit Application APR 17 2097
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucit; unty, FL
2300 Virginia Avenue,Fort Pierce FL 34982 i
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential i
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line rC��
PROPOSED i" PRoVEMtNT'LOCATfON: .
Address:
Legal Description:
Property Tax ID#: ��-t'� � I - 0645- US--] Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D -TIL DES'CRI:PTION OF,V1/ORK = .
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CQtNSTR.UCTION INFORM'ATLON
Additionalwork toa nertormedd ec
under ispermit-c 'a tappy:
❑_HVAC Gas Tank Gas Piping _Shutters Windows Doors
Electric ❑ Plumbing ❑Sprinklers ❑Generator Roof Roof pitch
Total Sq. Ft of Construction:�/Q.O 00 S . Ft.of First Floor:
Cost of Construction:$ Utilities:]Sewer OSeptic Building Height:
'0WNER/LESS,EE CONTRACTOR:
Name l�fl Name:
Address: Company: fflC_
City: State:. Address: l�
Zip Code: Fax: City: State:__ '
Phone No. 2 - �06 4`63L Zip Code: `Z pFax�-L&D � 3
E-Mail: Phone No. - r O
Fill in fee simple Title Holder on next page(if different E-Mail: S
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
S.UPP;LEMENTAL CONSTRUCTION LIEN LAW INFORMATION
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:
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.
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Signatlllo caner/Lessee/Contractor as Agent for Owner Signat Contractor License Holder
STATE OF FLORIDA STATE OF FLORIDKI
COUNTY OF � .PTCI COUNTY OF I,1 G If
The for oing instr ment vka acknowledged b fore me The forgoing instr ment was acknowledged before me
this 'n day of 1 20 1by this 4-day of 20 �by
i
4m6s'
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu lic-State of Florida ) (Signature of Notary70R
lic-State of Florida)
Personal) Known J OR Produced Identification Personally Known Produced Identification
Y
Type of Identification Produced Type of Identification Produced b
j�g
Commission No. ks (Seal) Commission No. � (Seal)
KARENS. NIELSE
a+
Commission 11Z `��puq,,,
•_ .a�a�'% KAREN S. NIELSEN
Revised 07/15/2014 a,.= My Commission Expires
+,�u•r.°': June 1 2, 201 8 ;,. ,_ Commission# FF 115637
- oe�: My Commission Ex ires
une 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS NGROVE
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DATE
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INITIALS