HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: O �O
W M _ � ¢_ ill` RECEIVED
�. Jaw
Building Permit Application SEP 01 2W
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Vrginia Avenue,Fort Pierce FL 34982
Phone:1(772)462-1553 Fax:(772)462-1578 Commercial _ Residential
PERMIT APPLICATION FOR:
Address: ti a S �'. �S 41 C�j W A-i ?Off I SAl ff C.tl(i c �-
-Legal-Description: X90 i 1 .
Property Tax ID#: 'to lo Lot'No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: . Left Side:
:15§
U A 0 _a_ s F ;2_ ?O s Fur
SSS ia� tam l.►.� of
4e. A--i 4 Es A.)
'3 „t3:S'isL'+,...:•y;�.a�s .�`F >;':'.:f4L" .' ,,..,a sV.n`i` 5,..hs�^ ".: ,d.r* `'M• +•{"""�� .�w"t, ,:S..fir 'f-"'y "sem ,.:.3 '4.," x' �}°.=" r':
= $s Y� � y.
Additionalworkkto be pertormed under this permitcneck all that appy:
t Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:.$ o'Z�, 6-% Utilities: _Sewer _Septic Building Height:
(� � �st'L7
i� �: f0'Q 4E, . +
Name 2A eiv- LF' Name: R—AiJUSC.0 A- 2QLjas:: A
Address b M h f A ST•. Company: e4 S C-0 4l2
City: 13�y! A1� State: Address:.___134 .___IAij cacrt-ri, 2�
Zip Code: 1Lf RDA Fax: City: To State:I'L-
Phone No. Zip Code: 33 402 fax:
E-Mail: Phone'No S� 1 - � (13 D D
Fill in fee simple Title Holder on next page(.if different E-Mail 0.13Wgff1L!300 P- 6/Mst/I, C")n2
from the Owner listed above) State or County License C J4 C J%4 ( i
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
ATT
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 theermit 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, consylt_- with lender or an attorney before
commencimig i&orkor recordin your.Notice !
otice of Commencement,:".
Signature of. r ssee/Contractor as Agent for Owner SI natur ;of ont or/Lice se Holder
STATE FLORIDA ST FLORIDA 1
COUNTY OF V4. COUNTY OF 1.SCJ
The forgoing instru ent w s acknowledg before me- The forgoing instr ment w s acknowledgegbefore me
this day of 201by this�day of 20 '( by
A�C(SC'(i k-_eA11:Q.1 SCS bf0%4\
(Name of person acknowledging) (Name of person acknowledging)
\ c
V
(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 ion Type of ldentific=n
Produced L D•L,, Produced L^ �• �'•
N S. NIELSEN :J,,,,,
Commission No. � . ommission No.r 5 0 ��, �( iN,S. NIELSEN
C i sion#FF 115637 ommission#FF 11563
=• •' a
My Commission Expires
�P,g. "s,�,ffo o',.i My Commission Expires
�, m• 8
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DATE
RECEIVED .
DATE
COMPLETED'
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