HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �2— l j���� Permit Number:
V ED
Building Permit Application
DEC 19 2011
Planning and Development Services PER;AI TING
Building and Code Regulation Division 5t. Lucie County, FL
2300 Virginia Avenue, Fort Pierce FL 34982 ^
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential 5
PERMIT APPLICATION FOR: 'YiGFI
Address: / �, H w• A o c
Legal Description:
Property Tax ID#: 2 d Z Z Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front _ Back: Right Side: Left Side:
DETAILED DESCRIPTION"b"'t WORK:
CONSTRUCTION INFORMATION: _
rtiona wort tom perForme�c un er t is permit-cKeckall that app y:
_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: $ Utilities: —Sewer —Septic Building Height:
Name t"t A07 r7J L 3y"L Name: �
Address: D 8S 14 el Company: r,✓ /rot i a 1
City: (� tti ��� / State:4L Address: D/ r r
Zip Code: �� Fax: City: T rZ r Stater
Phone No. ? Z - 2_,:2 /Z j %' Zip Code: ? Fax:
E-Mail: Phone No ���� z`ill
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License c�2 /c�
G1� L
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencJng work or recor&g your Notice of Commencement.
�7g-n6fuTelof Owner/Lessee/Contractor as Agent for Owner AKatrre6f Contractor/License Holder
STATE OF FLORIDA . STATE OF FLORIDA
COUNTY OF I,�UC�,I�_ COUNTY OF
The-fptgoing instrAAtnei1t was acknowledged-before me The forgoingInst ent was acknowledge efore me
this�day of 20 )�' /by this tl-�'1t day of 20 by
1
cAJ
(Name of person acknowledging of person ac)knowledging)
KAREN S. NIEL EN
s. Commission#FF 11 637 ,`;:'��'�•, KAREN S. NIELSEN
My Commission Ex fres =�•° *_ Commission# FF 115637
F OP
(Signature of Notary Public Sta ture of Notary P fftif„ j,T, of Flooda4 12, 201'8
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.