HomeMy WebLinkAboutBuilding permit application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �
Date: CO' Permit Number: }11l0
I ^ C� 47
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_ Building Permit Application JUL 0 6 101c
Planning and Development Services PERM 1-r i NG
Building and Code Regulation Division St. !uc'� s'cunty, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: I ���CL
PRO®POS,E® �'N;PR®1/EMENT LOCATI®N:
Address: 2-7 0 (p w iN-L {C er .acs P
Legal Description:
Property Tax ID#: .L-L; 806 "(-D q, Lot No.
Site Plan Name: "5-4a&al= f )PJ f+2# Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Dfl'AILEpD DESCR'fPT10'N ®F WORK:
CONSTR•11CT'I®N INF�RIVIATI®N:
itiona worktobepertormed under this permit-check all that appy:
M chanical _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: $ Utilities: —Sewer —Septic Building Height:
NEW-
ME—R,"MUSSI CORMRACI"QR
Name S rt- A I/I Name: e Yh'
p c
Address: T�L (Q i�X $(� Company: E< <S'.�,��-/ 6lBFT •c.lG Seryl-
City:
eg✓City: IN("A'My x State:_ Address: 1b 11 q S a) ?/I k,,)-e- t9-yz
Zip Code:b A43 Fax: City:,-T CT- 1'dzJt'e State:�G
Phone No. Zip Code: 34 15:1 Fax:
E-Mail: Phone No6 f 5 �-?' /7
��
Fill in fee simple Title Holder on next page(if different E-Mail E,5K ), yZ�J�AV�L� �-�Wi rL Coh
from the Owner listed above) State or County License_6/.1..-Lb %N 2�2
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
St1PPLEl�IENTAL CONSTRU�T'I.O,N LIEN L.�11V INFOR11�A1"lON -
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.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of ntractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF I•
The forgoing instrument was acknowledged before me The forgoing instr ment was acknowledged before me
this�day of 204 by this day ofI I I!� ___, 20� by
(Name of person acknowle ging) (Name of person acknowledging
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida) /
Personally Known OR Produced Identification ✓/ Personally Known OR Produced Identification ✓
Type of Identific °n Type of Identificat'o
Produced L% � Rr- -�•L
KARENLSEN _
Commission No. ='•'= a Commission `F ����it�mis on No. � - _ _-
*�� *= pqy Commiss on Expires KAREN S.
°P"" NIELSEN
< ��'r June 12, 2 1 8 ;_ Commission 4 FF 115
0:f - - 37
-.,r.Ifaln o: Y Commission Exp
OF K��'Q����, n C '? Expires
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATI0- .� - ROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014