HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: y 1"M 1 Permit Number: l ��
RECEIVED
Building Permit Application SEP Of 12011
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:1772)462-1553 Fax:(772)462-1578 Commercial _ Residential
PERMIT APPLICATION FOR:
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Address: 101-a S S'. QS- 41 A4 W Ami P0971` SAj.-i ` CdC i e
Legal Description: 1.111 9
Property Tax I D#: . 3 LtA _ S - 1501)4- 1bn Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: . Left Side:
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Additional work to be pertormed under t is permit-cheCK a 11 tat appy:
V 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:.$ 6-N Utilities: _Sewer Septic Building Height:
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IN
Name �i"G, c'TD RA bz L� Name: f;9AiJ(jSU A-- DA s
Address: b:4 M N i A ST-. Company: U S C_Z 4i/Z,
City: 211 T*ALA) State:A�i Address:...._��.�_-- 1.4j.JC&7T1Z ZO- -
Zip Code: 14 Q�.:4 . Fax: City: State:F'f
Phone No. Zip Code: 33 k&) (-j fax:
E-Mail: Phone No ( - _T:5r'A L13 0 U
Fill in fee simple Title Holder on next page(.if different E-Mail �S I�'y�(/t, 3oo /Ms►/y. f.�rr�
from the Owner listed above) State or County License fp(o ; I __._..._. .
If value of construction is 2-50 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:
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 thepermit 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 firs pection. If you-intend to obtain financing, consylt-.with.lender or a6attorney before
commencitqg iWrkor recordigg your Notice of Commencemen! `
:Signature of r ssee/Contractor as Agent for Owner $11 natur of ont or/Lice se Holder -
STATE.Of FLORIDA ST FLORIDA 1
COUNTY OF COUNTY OF l.�Jontp
The forgoing instru ent w s acknowledgbefore me The forgoing instr ment.w s acknowledged me
this day of 20� .by this day of 20 IT by
AZ SCO � .65AN
(Name of person acknowledging) (Name of person acknowledging)
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(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 Identification Type of Identifilff
Produced FL. D•b Produced �•�-' .
Commission No. I � ommission No.r I a� an,, .EMIR N S. NIELSEN
C' sion N FF 115637 ommission# FF 11563
z My Commission Expires -
's�,?o c M.y Commission Expires
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE
MANUKUVE—
COUNTER REVIEW. REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED .
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COMPLETED
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