HomeMy WebLinkAboutBuilding Permit Application i
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: �. ��' �� Permit Number:
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Building Permit Application AUG 17 261;,
Planning and Development Services P`P;,i n-nNG
Building and Code Regulation Division 5t. Luc-_ County,
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax. (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Rid R, INTI OZ 1 ENT LOCATION:
Address: 6 SID tet' � d kno-Y t<W1 t rc-e - 3 V '
Legal Description:
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Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DEQ-SCR PTION Of WORK: -
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CONSTRUCTION INFORMATION:
ff- 1 ional worK to be pe orme un er MIS permit-c ec a tat appy:
_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: $ Utilities: —Sewer _Septic Building Height:
OWNER/LESS, @ CONTRACTOR:
Name e-S pr& LL-e— Name: U4�, u
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Address: lot) t mctt r� Company: C�e`T� '� Cbito-Tq �}cH . roe---
City: State: Address:
Zip Code: )07 Fax: City: S -cc����` State:_a_
Phone No. " Zip Code: 'I Csb Fax: d
E-Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SlJ!PPLEMfNTAL C®NSTRIJCTI,®N LIEN LAW -I R,
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
commencin rk or recording our Notice of Commencement.
Signature of Owner/Lessee Contractor as Agent for Owner Signature of Contractor/License Holder
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STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFA. COUNTY OF
The forg ing instr ent was acknowledged efore me The forgoing instru 'ent w s acknowI d1g d before me
this day of 20 by this�day of 20 by
Y----u via
(Name of person acknowledging) (Name of person acknowledging)
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(Signature of Notary Public-Slate of Florida) (Signature of No ary Public-State of Florida)
Personally Known OR Produced Identification Personally Known .OR Produced Identification
Type of Identification � ,I' of Idea fication
Produced l �� �- oma_` �!E -Pro ced �,
t:h.i2ut S ?;, 'a%, KAREN S. N)ELSEN
Pve_ issiOn FF 115037
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Commission No. , - > _' {se (a Con mission Exp 'Commission No. fd='_". - ��'�'t })io.n;t FF 115637
s: ,.tiA✓, 2 i Y Commission Expires
°-I! June 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. /2014