HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED-FOR APPLICATION TO BE ACCEPTED
Date:- • Permit Number: - 34 1 " .,
—RECEIVED" '''.
• - JUL.. 3 G0��' i
-----_ flding Permit Applicatio
4 , ;,, :, 5T. 6ucie,Gounty, Perm�_r r 1
Planning End Development Services _- _
Building and Code Regulation Division .
F 2300_Virginia.A_venue,-Fort Pierce-F134982-
Phone: (7.72)_462-1553- Fax:-(772)462-1578- . Commercia' l' ReSldential� i
PERMIT APPLICATION FOR tv'1
lj
C?P r� wp DIM`'
Address: "jo 1 tc, 1A, P,%Q' ice:E
Legal Description:
f °
t Property Tax.ID:#; Lf D2 (p. �` CG 3'`? `GOA �. • L•ot No:''�3 '
Site Plan Name .,t Block No. .$5
• 1`' - ` ;. .., ."i: ._ .- .. 1 , - �. .. •' ',r,M "t j'
Project Name:
r Setbacks Front Back Right Side LZ ;: Left Side:
t
' 1STsRT1N'
itiona wor to be pertormed under this permit—check all tat appy:
Mechanical— _Gas Tank Gas Piping _ _Shutters =Windows/Doors ,
_Electric _Plumbing —Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
' Cost of Construction:'$ l(��` 'Utilities: _Sewer =Septic Building-Height:=- =1
-.
� »-�•� � �as _.4 ;. _ R <� � � � �.y;,•..ozr•q , *
WIN
- - U-0-0, 1114",.�" ..
ri
Name `A �_ S ,. ., Name:
h
Address: f`c�_ J �c' f lr ['Q� Company: r;.
City: P\SQA Com.
Stater 'Address:• 5'.=- C�� r
Zip Code:a4!?J R_ Fax: City:_\: \'y AC�2 State:,
Phonq o. �7`7a,�� 7%� Zip Coder ^ Fax•'7r2'S�l:
E-Mail: -- Phone No /a c/6--
Fill in fee simple Title Holder on next page(if different E-Mail ,SL�v Q L e�tw
from the Owner listed above) State or Coun y License 1
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Not Applicable "
pp 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 Appji.cable,.,
Name: Name: }
Address: Address: ,
City: I . :>,;• ;3 City:
Zip: - Phone: Zip: _ Phone: !
OWNER/CONTRACTOR AFFIDVIT:Application is hereby-made to obtain a permit to.do thework and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of&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,-1 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,-wails,-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 riterid"to obtain financing, consult with lender or an attorney before'
commencing work or recording ourflotice of Commencement:.
5
Signa re of Owner/Lessee/Agent Signature f Contractor/License Holder ;+
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF _ COUNTY OF' .. l
The for oing instru ent was acknowledge efore me The for oing instru en was acknow_ledge efore me
this day of 20 by this day of
y 20. -by
(Name of person acknowled ing) (Name of person acknowledging)'
(Signature of,Notary•Pu lic-,State ofiFlorida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification; Personally Kn �""
Type of Identification Y Type of Identi _ I `�=State of Florid NfELSEN"
; , KAREN Produced a= Commissio ?'Notary Public
Produced a� S• NfELSEN f� 2o_aa4
p1 Com iorida-Notary Public "- - - - """��� - -�emission it -
mission a 12, Exp s
Commission No. % �F,F��"�` MY•Con(S GG,,20.7484 Commission o. ZD aI�
ion Expiras _
June 12, 2D7.2
REVIEW_ S FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER- `REVIEW REVIEW -REVIEW REVIEW - REVIEW REVIEW
DATE
RECEIVED .�
DATE
COMPLETED
Te—v.-772014 - - -
„ :a:.