HomeMy WebLinkAboutBuilding Permit Application All'APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application JUN P, 6
Planning and Development Services PERI.4117ING
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:
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Address: -ILA911V 7q tfG n9
Legal Description: 7
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Property Tax ID#: in. 0 2.,UK—Nr , Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF WORK , ,, � ,
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Additional work to be performed under this permit-check all that apply:
_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: $ (D - 6) 0 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE 1 1"
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Address: ,3..1-W AIDIN .4V
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City.-7'iv)-/ S � 4h4 State: & Address:c3A &-/ Sti) 400ilol ZfUij
Zip Cocle:291-2 Fax, I City: POIJ- S+. Lkt�Q' — State: (IL.
Phone No. 77ri Zip Code: dtM s Fax: 7 7.1- 777-Ye
E-Mail: Phone No 7 2;- - 7 7 7 - L/C
Fill in fee simple Title Holder on next page if different E-Mail R11 ' ., V grePA #-'06 N9FZ-6V41 ?
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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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DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEESIMPLE 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 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 Ofmnerl Lessee/Contractor as Agent for Owner Signature of Co tractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF �J J�,IF, COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrent was acknowledged before me
this day of 20� by this-(_O-day of 20 j-7 by
Him 6 H P it Vf-n(Name of person acknowledging) (Name of person ac now edging)
I __=�4A �� a-
(Signature of Notary Public-State of Florida) / (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification P/ Personally Known OR Produced Identification
Type of Identification Type of Identification�
Produced �; —-- ~ �"' ed ('. C1)I.L=.
"P,Y'P KAREN S. NIEL• EN
ommission ;r FF 115637 m�
Commission No. - deal �s�m fission No. —
�'§'�'{ y Commission Cx iic
5NQ;4C �P pY PU O-oKAREN S. NLSEN June i 2, 201 Pa'
commission # FF 115637IE
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION -- `o; une 1 201 s
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7 4
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