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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 /r�1 Date: Permit Number: \ O ono .RECEIVE® Building Permit Application JUL o 3 201 Planning and Development Services ST. Lucie County, Permitting Building and Code Regulation Division 2300 Virginia Avenue,Fort Pierce FL 34982 Phone: (772)462-1553. Fax: (772)462-1578 Commercial Residential PERMIT APPLICATION FOR: v PRQ'POSED !N°PROUEM --fi T 11 CATIQN: Address: -� 2 stLyl:/2 C�,/}-1C-- Pr ST 4 zwr,i/= Legal Description: Property Tax ID#: Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAfiLED DESCR)`PTION O'F WORrK: G c e> CC�3' STRUCTIC�N INF©R 107,l'NT1 ION: Additional work to be performed under this permit-check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors _Electric _Plumbing V _Sprinklers _Generator _Roof Pitch 0 Total Sq. Ft of Construction: Sq. Ft. of First Floor: 00 - Cost of Construction: $ 2 3 b Utilities: —Sewer —Septic Building Height: OWNER I]IPs IE: Cf+3NTRA QR: Name fl 0 Af/Tr e�04/4 ita Name: -12fe-14- Cr 4-4/C"-a Address: S2 S/LylZ2 Company: r/tii Gf'0t4-1'r�r i3 S -)?wC City: State: Address:. G / 57 .4 Zip Code: Fax: ,I City: 4✓ State: Phone No. 2 V/ 'J-o Zip Code: •3 9 9 / Fax: E-Mail: Phone No "7 7 2 - 2 o l ^ "- 9, 2 a Fill in fee simple Title Holder on next page( if different E-Mail (-/A1/5 I+Oi-*, -s r3 y ILi�tcX� �/1yi3icr from the Owner listed above) State or County License -cG• t. dS3t/o • cp If value of construction is 2500 or more,a RECORDED Notice of.Commencement is required. SUPPLEMENTAL C©NST U 1©N LIEN LAW ( FORMATlD 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'applkcable 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 commencing or or recording our Notice of Commencement ell lk, Signature o Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA I > _ COUNTY OF i(�,I� COUNTY OF _ L1)C�' (� . The fo going instrument was acknowledged efore me The forgoing instru en was acknowledged before me this T day of 20by this l day of 204 by (Name of person acknowle ging) (Name of person acknowledgingAA 44 ) 1 1 _ (Signature of Notary P ) / (Signature of Notary Public-State of Florida ublic-State of F orida ) Personally Known OR Produced Identification V Personally Known OR Produced Identification Type of Identificaion Type of Identificpion Produced 1_- Produced `car°`e' ,,.....r,, KAREN S. NI.CLSEN =; � Sra a�'gatla NIELSEN Commission No: „�Y°"B� to of Flgrjd l otary Public Commission No. *- i '. •a Commission # GG 207484 ,, o Cora Notary Public Q;� NAY,commission Expires % rnissi 484 o' eS11 �-� 2022 REVIEWS F; ONING SUPERVISOR PLANS VEGETATION SEATURTLE. COUNTER REVIEW 'REVIEW REVIEW REVIEW 'REVIEW REVIEW DATE RECEIVED - DATE COMPLETED" ev.