HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _1 30 1 1'� Permit Number:J !
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RECEIVED
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Building Permit Application JAN
Planning and Development Services ST, 6meie Count
Building and Code Regulation Division Y, PermittlnJ
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2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED INPROVEMENT LOCATION:
Address: -1 ,DLA SgAar-d ?'h F. Vie -Le- . F(. -2N95 1
Legal Description:
Property Tax ID#: 1302-0410- 8015 1000 5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be per orme mer this permit-check 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: $ 100- Oa Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name o.'f i Name: i- L !s >
Address: t�ib %9 and �a Company:��p .
City: -V4- . 1 >I'tf'e' State:FL- Address: -19OZ OUVNIOSA 2
Zip Code: _2bLAIK;1 Fax: City: >Le c-e_ Stater
Phone No. 1-1Z 63q-0115 Zip Code: _9zA0k51 Fax:
E-Mail: Phone No D -5-1
Fill in fee simple Title Holder on next page ( if different E-Mail (3�t,�e.S�:xd'E��L' �c-�-�-�-�q►'
from the Owner listed above) State or County License
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
commencin k or recording r Notice of Commencement.
J�411'e
Sig r o Ow r/Les /Contractor as Agent for Owner Signatu nt actor/ icense Hol
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF ILI
Th or oing instru ent was acknowledge before me The f ing instrument was acknowledgepefore me
thi day of � 20-R tr by this�Q day ofdaki 20Ja by
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(Name of person acknowledging) (Name of person acknowledging)
tA L� a dje��
(Signature of Notary Public-State of Florida ) (Signature of Notary Pu lic-State of F)orida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifi n Type of Identific�
Produced roduced ILL Q
KAREN S. NIELSEN
ever,,
Commission No. c{S@f)ssion # FF 115637 ommission No. (Seal)
- My Cornmission Expires
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June 12, 2018 �r�p`°- KAREN
OLN
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATIO TURfI�o"n 'MbAN �
COUNTER REVIEW REVIEW REVIEW REVIEW ne 12REU'IFS
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