HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED H
Date: �' `' ` Permit Number: l ��
-low RECEIVED
Building Permit Application SEP 0`1 2d?17-
Planning and Development Services
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie County, FL
Phone:Y(772)462-1553 Fax:(772)462-1578 Commercial _� Residential
PERMIT APPLICATION FOR:
Address: S �_ :DS 4)eA W&'i � ?Oi'LI �'AIrJ'f CtdGe PL --��
Legal-Description: �� -
Property Tax ID#: 3 '1 A Y sol S fro,4_ 160 Lot'No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: . Left Side:
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Additional wor to be pertormedd under this permit-check all that 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:-$ 02�, 6N Utilities: _Sewer =Septic Building Height:
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Name_] S' (ZA �erc �—� Name: }— �GSt✓'J A-- D41c�,;��
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Address:; b M Py i Company: eA S C,,0 412
City:,, State:_ Address:. 13�f_.__t aa:.�LAC it at l P-O -
Zip Code: 1 y Fax: City: State:FL
Phone No. Zip Code: 33 Y, 19 Fax:
E-Mail: Phone No 1 - Xl�A q3 -6 D
Fill in fee simple Title Holder on next page(.if different E-Mail f�lS��21�. 300 C/Ms►! , f.��'►�
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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 Count 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 andcovenantsthat 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-.With lender or an attorney before
commencimg iWrkor recording your Notice of Commencemen e.
-Signature of. r ssee/Contractor as Agent for OwnerS. natur of ont or/Lice se Holder
STATE FLORIDA ST FLORIDA 1 , '
COUNTY OF I COUNTY OF l. J
The forgoing instru ent w s acknowledg before me The forgoing instr ment w s acknowledge efore me
this�day of 20�I 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 Identific,a�nn
Produced L. �•�.% Produced V L• �•�• .
N S. WE
Commission c
Commission No. -* ,*_ � - ommission No.r 5 -*o �( YN.S. NIELSEN
C i cion k FF 115637 ommission k FF 11563
My Commission Expires
it yo : M_y Commission Expires
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REVIEWS FRONT !:ZONING SUPERVISOR PLANS VEGETATION SEATURTLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED .
DATE
_ COMPLETED'
:Fe-v-.7/2014