HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:;(�� ���_� Permit Number: �Mo UU�,
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Building Permit Application JUN P 5 201
Planning and Development Services PER[�fi[lTINI z
Building and Code Regulation Division 5t. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 COI' meC'Cial Residential
PERMIT APPLICATION FOR: ��-ckCztG VEL .
11111010NIM MEN=
Address . rj%,,gK ,4G- Q c Tem Lh
Legal Description:
Property Tax ID#: S 3 a " CK& 060 - Lot No.
Site Plan Name: Block No. .
Project Name:
Setbacks Front Back: Right Side: Left Side:
ARE'1iN
Additional woobepertormed under this permit-check all that appy:
_Mechanical Gas Tank _Gas Piping —Shutters —Windows/Doors
i Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ 9 ZDo Utilities: —Sewer' _Septic Building Height:
Name Name: r—rill, <J-6Q f'y14Au
n
Address: � Company:
0,1,t!5 v�,L
p Y�
City: - P , ,4,1,4 State:_ Address: S�U a v� .Q
Zip Code: Fax: City: JC�. Pi �IrG� State:
Phone No. �U` I H 11 Zip Code: 3 1'1(/-7 Fax: q&6 "a-mo
E-Mail: Phone No. �lL('6
Fill in fee simple Title Holder on next page(if different E-Mail: W Ce D�7 i fn c. Cf Q CGw.
from the Owner listed above) State or County Licenser 13 D 0 S--5-1 7
If value of construction is 2500 or more,a RECORDED Notice.of Commencement is required.
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 thatlis 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/.Agent/Lessee Signature of Contractor/License Holder
STATE OF FLO I A STATE OF FLORIDA
COUNTYOFCOUNTY OF
The forgoing instrument was acknowledged before me The forgoing instru ent was acknowledged before me
this -day of - 20]� by this_5_�day of E 20_LI,by
(Name of person acknowledging (Name of person acknowledging)
AA
(Signature of Notary Public-State of lorida) (Signature of Notary Public-State of Florida) /
Personally Known OR Produced Identification Personally Known OR Produced Identificationy
Type of Identification Produced N e of.Identification Produced (; D•L
KAREN S. _
Commission No
I J �'^°pv❑Up{�'�-(Sre81)miesion it FF 1156 7C mission No. p .`""""' N S. NIELSE�!
l °= .Niy Commission Expires *>°o
�' Commission S FF 115637
s\�s� Q° June 12, 2018 ;,; „_
MY Commission Expires
Jun a 12, 2018
REVIEWS FRONT ZONING . SUPERVISOR PLANS VEGETATIO
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014