HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPUCATION TO BE ACCEPTED
Date: • , Permit Number: 111 C)-1 �9
Building Permit Application
RECEIVED
Planning and Development Services SEP- 012017
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue,Fort Pierce'FL 34982
Phone:`(772)462-1553 Fax:(772)462-1578 Commercial _� Residential St' L1C1e Co.un;Y, FL
PERMIT APPLICATION FOR:
�..� MON
�. F iGs..r:$" ,� i.
Address: I 0'>r,25 �'. 5 l�W�i '�oi2i S'Ai�s LtlPw
-Legal-Description: iT
Property Tax ID#: 3 '1 / y- S o i S fro 4- 1 bQ Lot'No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: . Left Side:
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.mak: 8"✓S'€ fY3 '#.'3 '�y,t`A
.UA &E _0.0 ipf ,2 .9 700 sPUT SVS�iy1 11.J.I.:I�F go
40-A-;
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Additionalwork to be performecl uncierthiS permit-checK all that app y-
a/tMechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:-$ 65 Utilities: —Sewer _Septic Building Height:
��
.t:..- er ,et •,,... sc R i :,. ._,rte
Name (?A 6c �, L P Name: - FtAiJ QS C,' A, DA.t�S:�A
Address: I't it, S"T•. Company: eA.S C,.7 /!L
City t11 E#-ALD State: Address: 1Aj-J CAC. IL ,2 L
Zip Code: 1 t-t'Q�_ Fax: City! SO4jjT0" ',i�.irjaw- State:rf
Phone No. Zip'Code: �4L) G 'Fax:
-E-Mail: Phone No (-i 3 b D
Fill in fee simple Title Holder on next page(.if different Cgg)n2
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
PATiol-S-11
0011RAII,IN
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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 con lict.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.
Inconsideration 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
commencif9g or or recordigg your Notice of Commencemen ! `
Signature of. r ssee/Contractor as Agent for Owner S natur .of ont or/Lice se Holder
STATE FLORIDA ST FLORIDA 1
COUNTY OF COUNTY OF
The forgoing instru ent w s acknowledg before me The forgoing instr ment w s acknowledge efore me
this day of 20� by this day of 20J_rt 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 v� Type of Identifi n.
Produced c D:L Produced �•
,• I.,� F�N S. NIELSEN
Commission No. l �,�_ Od T cion R FF 115637 ommission No.r ' i 5 0 .,,, .&M N,S. NIELSEN
• R My Commission Expires =• .= ommission ft FF 11563
: M.y Commission Expires
8
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED .
DATE
COMPLETED
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