HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED.FOR APPLICATION TO BE ACCEPTED
Date: 0-b SSV" ,)-U 1 Permit Number:
RECEIVED
_ •.__ Building Permit Application
SEP 2 8 2011
Planning and Development Services PERMITTIN-,
Building and Code Regulation Division St. Lucie Gounly, F11-
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential ✓✓✓
PERMIT APPLICATION FOR:
P[RQRS'EaD NP 01/E ENT L®C T QN.
Address: /V C/
Legal Description:
Property Tax ID#: ` ( 00(3' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
:tmo
.� :PL
C�, S�TR'11CT10' I `FORMA 10'N. .
4-
Additional work to be peg orme ,under this permit-gheCk checkall that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows Doors'
_Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: / a' S� �r Sq. Ft.of First Floor:' - '
Cost of Construction:$ 7 Utilities: —Sewer _Septic Building Height:
W N ER 'LE�S�S CO TR 0
Name = -t__ ¢ L`U ' yf Name: = w a.;
Address: Company:` ` �rjc 11vZr!`!` �
City: •• ;//iii/-- State:�L Address- _
Zi Code: Fax: City: Stater
P �C •
Phone No. -?DS 5,>-e- f��'� Zip Code: - 91-1 / s/ Fax:
E-Mail: Phone No )-VLO -0?JY
11
Fill in fee simple Title Holder on next page(if different E-Mail �1Y�'I / •G
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: . _Not Applicable MORTGAGE COMPANY:' _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE T,!TLE: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 roomsand 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 first insp tion. If you intend to obtain financing, consult wi h lender or an attorney before
commencing Work& recording our Notice of cementvl
i
Signature o e Lessee/Contractor as Agent for Owner Signata o C ractor/License Holder
STATE OF OI STA OF FLORIDA
COUNTY � i J�,�E. CO TY OF
The for ing instr ent as acknowledged before me The fo oing instru ent as acknowledged before me
this day of 20jl by thiso day of 20L7 by
V440 JJk4 Pro FA�, 0 Ro 4
(Name of person ack owledging) (Name of person ac nowledging)
(Signature-of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida)
Personally Known V OR Produced Identification Personally Known OR Produced Identification
Type of Ident'fic tion Type of Identif' ti
Produced Produced (.
�'•�*� KAREN'S. NIELSEN ��'•� ° �omREN.$ ��S�N
•_ Commiss FF 115637 Commission No. '; "(l &jJ,�NFECommission No. (9eati1)Y Commission Expires °`,;;° yCommission 15637
June 12, 2018 Jane 12 Expires
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGR
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Re—v.7/2014