HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE 1INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 ' Permit Number: ir''(`Oq' O O 4
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Building Permit Application SEP a•1 2V
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:1(772)462-1553 Fax: (772)462-1578 Commercial _ Residential
PERMIT APPLICATION FOR:
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Address: 10� .�.S �'_ _S 41OJ4 W Ami — ?Q i21 SA i.01- C-00'e
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Legal Description: �,1b�iTti�
Property Tax ID#: . 3 LI A L1 _ 5ol— S oo,4- 1 bn Lot No.
Site Plan Name: Block No.
Project Name: °
Setbacks Front Back: Right Side: . Left Side:
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v. itlona wor to a pe orme under this permit—cneCK all t at apply:
a1/Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: Sq.Ft.of First Floor:
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Cost of Construction:.$a519, 65 Utilities: —Sewer Septic Building Height:
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Name��%r. 2A 6z LP Name: �—1 i�GSC,J
Address: M1X1 a ST•. Company: 'US C,,o R4/2
City:, TfALD State:. Address .....�.34—___i A-iJ wiC t a,- �
Zip Code: 1 Lf 2,-'LA� Fax' City: m State:Fi-
Phone No. Zip Code: 33 q..) (2 Fax:
E-Mail: Phone No 3 t? D
Fill in fee simple Title Holder on next page(.If different E-Mail p.1S� 2/t., 3o0 C/Ylsrl _ i.�rvf
from the Owner listed above) State or County License GA G- 1 IS (lb(q.i I_
If value of construction is 2500 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 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 firs • pection. If you intend to obtain financing, consult w_ith lender or an attorney before
commenci ork or recordin our Notice of Commencemen `
Signature of r ssee/Contractor as Agent for Owner $1 natu4 of,Cont or/Lice se Holder
STATE 06LORIDA ST FLORIDA
COUNTY OF UoicCOUNTY OF
The forgoing instru ent w s acknowledg before me The forgoing instr ment w s acknowledgegbefore me
this day of 1 20j� by this day of 20L by
(Name 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 ✓/ Personally Known OR Produced Identification
Type of Identific on Type of Identifi n
ProducedL. D Produced �. �•�'•
N S. NIELSEN c
Commission No. � � ommission No.r i' o� �.�,, .�( N,S. NIELSEN
z C i sion N FF 7 15637 _ - ommission k FF 1 1563
t- !-
z, .r My Commission Expires N r
3 M-y Commission Expires
., ..a ....n 8
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE N
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE.
RECEIVED .
DATE
COMPLETED
ev.