HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED DYE
Date:�� � Permit Number: 1 to 1��� y ` ,
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i — Building Permit Application
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Planning and Development Services St. Lucie o�;nty, 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:
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PRQPOSED INPROUEMENT LOCATIC►'N, r
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Address: Id, 1 J
Legal Description: I ��` ����`z ✓��°�
Property Tax ID#: 6> ^ d0c,'s-- 00 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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GONSTRUCTIDN INFORMATION
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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: [X Sq. Ft. of First Floor:
Cost of Construction: $ �, lJdy Utilities: —Sewer _Septic Building Height:
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01NNER/LESSLE
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CONTRAGTOR�
Name Nam
Address: 7 7 S— 'Company: U
City: 7Tt //
State Addres ��O � c5 -Fel l�R t --
Zip Code: 3 v Fax: City: A Irl Cr 1 State:-
1199 .
Phone No.c2 0 1- / Zip Code: � Fax:
E-Mail: A •L , &WL Phone No
Fill in fee simple Titl Holder on next page ( if different E-Mail `� & ' ,9 r1
from the Owner listed above) State or Count License 0 0� 7 07
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is equired.
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y � P`�f �' `a�: 13N�TR�ICT ON LIEN LAW INFORMATION '
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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 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.
Signa ure of Owner/Less t f n
on as Agener Signa ure of Contractor/ ce se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF I ILL
The f oing instrument was acknowledged before me The f going instrument was acknowledged before me
this day of 20a by this T day of 20T by
(Nalme of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification t/ Personally Known OR Produced Identification
Type of Identification Type of Identification /
Produced �� L. Produced • ��
>V"' Se REhJ S. NIELSEE< Omission No. i ;,,,,; I�.
Commission No. ( %j rpt J S. NIELSEN
3e ¢3 Commission tt' ;F 115G 7 Commission# FF 115637
My Commission Expire L'L `s 4 _ M Commissiori Fx fires
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REVIEWS FRONT ZONING UYLtTO "�4ANS VEGETATION
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE 1
RECEIVED
DATE
COMPLETED
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