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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 Date: Permit Number: yrs, e r v aw+n.• xc '��� �1 1 F " Building Permit Application JUS- 2 5 2011? PERIMI1-I iNG Planning and Development Services St.Lucie Coun - 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: PR©POSED INPROVEMEN'T LOCATIO Address: 6--e ti 1 S uji_eCr e,%z Ci r Legal Description: Property Tax ID#: X312-'9-01 —012 1 -0Cx­1 P Lot No. 116 2 Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left ide: MAI,'LED DESSR+I!`TION OWOR+K: P r_> �-J✓fir �.(� .�rr� �e� V CO'NSTRUC ION INFORMATION: Adaltionalwork'tobepertormeciunder this permit-check all that appy: echanical _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: OWNER/LE-�StiS E: ONTROME Name Name: Address: 5-9 7 5 01UQG,2✓g Clr/~ Company: C`. �Qw, r 7' e4f �t��Ty�rC/-�-c S'c l'✓ City: (=p/�i `t��,/n2 State: TG Address: /© 4 G -9 LJ Zip Code: 3t-( 0! 15-1 Fax: City: Pow. Sr State: FC- Phone No. Zip Code: 3 L+ q!3 Fax: E-Mail: Phone No 5 2 05119 Fill in fee simple Title Holder on next page(if different E-Mail �' Sr+7 �'i E/Se,�',/i c.e CQ I�►�i L'•lo�, from the Owner listed above) State or County License 62t 20 ?c1K)2 If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. S[J�PLEMEN AL CONS �R�U�C�+TIDN LIEN LAW IN�FORMATIO!N: 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, 1-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 commencin work or recordina vour Notice of-Commencement. Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contra r/License Holder STATE OF FLORID STATE OF FLORIDA COUNTY OF COUNTY OF The for oing instmet was acknowledged before me The forgoing instr ment was acknowledged before me this o� day of \\) 1 201a by this�day of 204_1� by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notaryublic-State of Iorida ) (Signature of Notary Public-State of Florida) Personally Known OR Produced Identification I/ Personally Known OR Produced Identification Type of Identific tion Type of Identif' ation Produced V- ��,�; Produced TT". U.L.gym . "�,Se KAREN S. NIE SC-&fnm sion No. Commission No. I �;>RYal) 1f �� (Seal) Commission# FF 115637� MyCommission E piies ��;NYPVo��, KAREN S. NIELSEN june i 1_� n -� =s x; - M commission Ex ares REVIEWS FRONT I' S P R�`/I O PLANS VEGETATIO-. ;:;, F '= TURYf ne 1yPAgiBOVE COUNTER REVIEW REVIEW REVIEW REVIEW (=- X41ff;1V DATE RECEIVED DATE COMPLETED lev. 7/2014