HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `� i:)1u-iq
-Di te: Permit Number:
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Building Permit Application
f Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential t/
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PERMIT APPLICATION FOR:
PROPOSED INS• ROVEMENT LOCATION:
Address: ,YA Z
Legal Description:
.Property Tax ID#: ll 9 5_/6 0/ 93 ow D Lot No.
Site Plan Name: . Block No:
Project Name:
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setbacks Front .2,5 Back: Right Side:� Left Side:
DE °A LED DEQ �R�IPTION O WaRI�.
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CONSTRUCT O IINFOR TION: -
Additional work to ,be-pertormed under t is permit-Check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator Roof Pitch
TI tal Sq. Ft of Construction:. Sq. Ft.of First-Floor:
Cost of Construction: $ ,�J'GO Utilities: _Sewer _Septic Building Height:
ON'ERjLE--S.SE CONTRA OR:
Name O^ Name
Address: �` (-c�: = Company: UQ C? fJi�N' �x. rZ. A� ��r?-✓u
State: '� LizCity:
Zip C;ode:
City: c °iZ `� .�c,c: ;e_ state:��
Phon6,Na. �� Z 3�Z -2.`a'S��� Zip Code: 3l'!9 Fax:
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E-Mail: - Phone No; Z
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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.U`P'Pl.E ENT 010
LIEN LAW 1 FORMA 10
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
commencing work or recording your Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder.
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF l COUNTY OF l�
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The f going instru ent was acknowledge efore me The f ling instr ent was acknowledged before me
this.7 day of' 20by this day of 204 by
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(Name of person acknowledging) (Name of person acknowledging)
it AA
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida) /
Personally Known OR Produced Identification I/ Personally Known OR Produced Identification ✓
Type of Identif tion Type of Identificati�
Produced Produced I ��
KAREN S. NIELSEN
, `Aga
Commission No. _:° State of Fiogqi% "�{otary Public Commission No. (Seal)
_* = mmissidn '6G 207484
%y+ My Commission Expires = r (;
/, OF F1.0`�� June 2 2022 KAREN
Uk; `= Com �or�ha_Not
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEG �C, F �f� L cG 2RN5 OVE
COUNTER REVIEW REVIEW REVIEW RE 1 C�bFfg sio xpiKVI
DATE
RECEIVED
DATE
COMPLETED
ev. /2014